2027 ICD-10-CM Diagnosis Code Z59.71Insufficient health insurance coverage
Z59.71 is a billable ICD-10-CM diagnosis code for insufficient health insurance coverage. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 951. The code is not accepted as a principal diagnosis by the Medicare Code Editor and exempt from POA reporting. Coders also document this condition as finding related to health insurance issues. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Socioeconomic/psychosocial factors.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for Z59.71.
Present on Admission (POA)Billing
Z59.71 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Persons with potential health hazards related to socioeconomic and psychosocial circumstances (Z55-Z65).
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Finding related to health insurance issues
- Insurance refused - medical reasons
- Medication not covered by insurance
- Uninsured medical expenses
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to Z59.71: its own notes plus those printed at Z59 and Chapter 21. A note printed at a category, block or chapter applies to every code under it.
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Inadequate social insurance
- Insufficient social insurance
- No health insurance coverage
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Notes
General instructions on how these codes are used.
- Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:
- (a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.
- (b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name Z59.71, its category, or a range that includes it.
Excludes2 2
These codes carry an Excludes2 note naming Z59.71: its condition is not part of those codes, and both may be reported when the patient has both.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
health insurance coverage Z59.71
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Code History & ChangesHistory
Replacement Z59.71 replaces the following previously assigned code(s):
- Z59.7 - Insufficient social insurance and welfare support
Questions About Z59.71Overview
What is the ICD-10 code for insufficient health insurance coverage?
The ICD-10-CM code for insufficient health insurance coverage is Z59.71 (sometimes written as Z5971). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is Z59.71 (Insufficient social insurance and welfare support) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report insufficient health insurance coverage on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does Z59.71 group to?
On inpatient claims, insufficient health insurance coverage maps to MS-DRG 951 (other Factors Influencing Health Status), which carries a relative weight of 0.5574. Higher weights mean higher Medicare reimbursement.
Can Z59.71 be a principal diagnosis?
No. The Medicare Code Editor rejects this code as a principal diagnosis because insufficient health insurance coverage describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.
Is Z59.71 exempt from POA reporting?
Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for insufficient health insurance coverage on inpatient claims. The code appears in the Persons with potential health hazards related to socioeconomic and psychosocial circumstances (Z55-Z65) range of the CMS exempt list.
