Z76.5 - Malingerer [conscious simulation]
| ICD-10: | Z76.5 |
| Short Description: | Malingerer [conscious simulation] |
| Long Description: | Malingerer [conscious simulation] |
| Status: | Valid for Submission |
| Version: | ICD-10-CM 2023 |
| Code Classification: |
Z76.5 is a billable ICD-10 code used to specify a medical diagnosis of malingerer [conscious simulation]. The code is valid during the fiscal year 2023 from October 01, 2022 through September 30, 2023 for the submission of HIPAA-covered transactions. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.
Approximate Synonyms
The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:
- Drug seeking behavior
- Feigning of symptoms
- Malingering
Clinical Information
- Malingering-. simulation of symptoms of illness or injury with intent to deceive in order to obtain a goal, e.g., a claim of physical illness to avoid jury duty.
Tabular List of Diseases and Injuries
The Tabular List of Diseases and Injuries is a list of ICD-10 codes, organized "head to toe" into chapters and sections with coding notes and guidance for inclusions, exclusions, descriptions and more. The following references are applicable to this diagnosis code:
Inclusion Terms
Inclusion TermsThese terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
- Person feigning illness (with obvious motivation)
Type 1 Excludes
Type 1 ExcludesA type 1 excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
Index to Diseases and Injuries References
The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10 code(s). The following references for this diagnosis code are found in the injuries and diseases index:
- - Behavior
- - drug seeking - Z76.5
- - Conscious simulation (of illness) - Z76.5
- - Disorder (of) - See Also: Disease;
- - feigned (with obvious motivation) - Z76.5
- - Feigned illness - Z76.5
- - Malingerer, malingering - Z76.5
- - Person (with)
- - feigning illness - Z76.5
- - Simulation, conscious (of illness) - Z76.5
Present on Admission (POA)
Z76.5 is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here.
CMS POA Indicator Options and Definitions
| POA Indicator Code | POA Reason for Code | CMS will pay the CC/MCC DRG? |
|---|---|---|
| Y | Diagnosis was present at time of inpatient admission. | YES |
| N | Diagnosis was not present at time of inpatient admission. | NO |
| U | Documentation insufficient to determine if the condition was present at the time of inpatient admission. | NO |
| W | Clinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission. | YES |
| 1 | Unreported/Not used - Exempt from POA reporting. | NO |
Convert to ICD-9 Code
| Source ICD-10 Code | Target ICD-9 Code | |
|---|---|---|
| Z76.5 | V65.2 - Person feigning illness |
Patient Education
Mental Disorders
What are mental disorders?
Mental disorders (or mental illnesses) are conditions that affect your thinking, feeling, mood, and behavior. They may be occasional or long-lasting (chronic). They can affect your ability to relate to others and function each day.
What are some types of mental disorders?
There are many different types of mental disorders. Some common ones include:
- Anxiety disorders, including panic disorder, obsessive-compulsive disorder, and phobias
- Depression, bipolar disorder, and other mood disorders
- Eating disorders
- Personality disorders
- Post-traumatic stress disorder
- Psychotic disorders, including schizophrenia
What causes mental disorders?
There is no single cause for mental illness. A number of factors can contribute to risk for mental illness, such as:
- Your genes and family history
- Your life experiences, such as stress or a history of abuse, especially if they happen in childhood
- Biological factors such as chemical imbalances in the brain
- A traumatic brain injury
- A mother's exposure to viruses or toxic chemicals while pregnant
- Use of alcohol or recreational drugs
- Having a serious medical condition like cancer
- Having few friends, and feeling lonely or isolated
Mental disorders are not caused by character flaws. They have nothing to do with being lazy or weak.
Who is at risk for mental disorders?
Mental disorders are common. More than half of all Americans will be diagnosed with a mental disorder at some time in their life.
How are mental disorders diagnosed?
The steps to getting a diagnosis include:
- A medical history
- A physical exam and possibly lab tests, if your provider thinks that other medical conditions could be causing your symptoms
- A psychological evaluation. You will answer questions about your thinking, feelings, and behaviors.
What are the treatments for mental disorders?
Treatment depends on which mental disorder you have and how serious it is. You and your provider will work on a treatment plan just for you. It usually involves some type of therapy. You may also take medicines. Some people also need social support and education on managing their condition.
In some cases, you may need more intensive treatment. You may need to go to a psychiatric hospital. This could be because your mental illness is severe. Or it could be because you are at risk of hurting yourself or someone else. In the hospital, you will get counseling, group discussions, and activities with mental health professionals and other patients.
[Learn More in MedlinePlus]
Code History
- FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
- FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
- FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
- FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
- FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
- FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
- FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
- FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016 (First year ICD-10-CM implemented into the HIPAA code set)