2025 ICD-10-CM code Z91.120
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Factors influencing health status and contact with health services - Persons with potential health hazards related to family and personal history and certain conditions influencing health status Factors influencing health status and contact with health services (Z00-Z99) Feed
Patient's intentional underdosing of medication due to financial hardship.
No modifiers are directly applicable to this ICD-10 code.
Medical necessity is established by the need for the medication in question, documented through the patient's medical history and current clinical condition.The intentional underdosing due to financial hardship demonstrates a barrier to proper treatment, justifying further intervention and exploration of financial assistance options.
The clinical responsibility involves assessing the patient's medication adherence, understanding the reasons for non-adherence (in this case, financial hardship), exploring options for medication assistance programs, and potentially adjusting the treatment plan to address the financial barriers.
- Factors influencing health status and contact with health services (Z00-Z99)
- Z91.120 falls under the broader category of Z91.12 (Patient's intentional underdosing of medication regimen), which itself is part of chapter Z (Factors influencing health status and contact with health services).
In simple words: The patient is not taking their medicine as prescribed because they cannot afford it. They are intentionally taking less medicine to save money.
This code signifies a patient's deliberate reduction of their prescribed medication dosage because of financial constraints.It indicates a situation where the patient is unable to afford the full cost of their medication, leading them to intentionally take less than the prescribed amount. This action can have significant negative impacts on their health and treatment outcomes.
Example 1: A patient with hypertension intentionally reduces their blood pressure medication dosage because they cannot afford the full prescription. This leads to poorly controlled hypertension, increasing their risk of stroke or heart attack., A diabetic patient, facing financial difficulties, reduces their insulin dosage to make the medication last longer.This results in poor glucose control and increases the risk of diabetic complications., A patient with a mental health condition intentionally lowers their antidepressant dosage due to the high cost. This could lead to worsening symptoms, potentially requiring more intensive and expensive care in the future.
Documentation should include details about the patient's financial situation, the specific medication being underdosed, the extent of the underdosing, and the potential impact on the patient's health.Notes about discussions of medication assistance programs and other potential solutions should also be included.
** This code highlights a significant social determinant of health impacting patient outcomes.Efforts to address the financial barriers are crucial for improving patient care and preventing adverse health events.
- Revenue Code: Revenue codes will vary depending on the specific services provided in conjunction with this diagnosis code.
- RVU: RVUs are not applicable to ICD-10 codes.
- Global Days: Not applicable to ICD-10 codes.
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD-10 codes.
- Fee Schedule: Not applicable to ICD-10 codes.
- Specialties:This code is relevant across various specialties, depending on the underlying condition requiring the medication, such as Cardiology, Endocrinology, Psychiatry, etc.
- Place of Service:This code can be used in various settings, including hospital inpatient, hospital outpatient, physician office, and other healthcare settings where the patient's financial status impacting medication adherence is assessed.