2025 ICD-10-CM code Z76.5
Malingerer (conscious simulation).
This code is not used to indicate medical necessity but rather to document a suspected instance of feigning illness.
The healthcare provider must document the evidence that supports the determination of malingering. This includes inconsistencies between reported symptoms and objective findings, lack of cooperation with treatment, and presence of external incentives.
- Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)
- Persons encountering health services in other circumstances (Z69-Z76)
In simple words: This code is used when someone is faking being sick on purpose, for a clear reason.
This code is used when a person is feigning illness with an obvious motivation.It represents a conscious and deliberate act of pretending to be sick.
Example 1: A patient claims severe back pain after a minor car accident to receive financial compensation, but medical examinations reveal no physical injury., An employee repeatedly calls in sick with various vague complaints to avoid work responsibilities, especially during busy periods or undesirable projects., A student feigns illness to get out of taking an exam or to receive special considerations or extensions on assignments.
Documentation should include discrepancies between subjective complaints and objective findings, lack of cooperation with diagnostic testing and treatment, and any identifiable external incentives for feigning illness.
** Excludes1: factitious disorder (F68.1-) and peregrinating patient (F68.1-). ICD-9-CM equivalent code: V65.2
- Specialties:All specialties.
- Place of Service:All places of service.