ICD-10-CM Code Z76.5

Malingerer [conscious simulation]

Version 2020 Billable Code POA Exempt

Valid for Submission

Z76.5 is a billable code used to specify a medical diagnosis of malingerer [conscious simulation]. The code is valid for the year 2020 for the submission of HIPAA-covered transactions. The ICD-10-CM code Z76.5 might also be used to specify conditions or terms like drug seeking behavior or feigning of symptoms or malingerer or malingering. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.

ICD-10:Z76.5
Short Description:Malingerer [conscious simulation]
Long Description:Malingerer [conscious simulation]

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 guidance for inclusions, exclusions, descriptions and more. The following references are applicable to the code Z76.5:

Inclusion Terms

Inclusion Terms
These 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 Excludes
A 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

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 the code Z76.5 are found in the index:


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
  • Malingerer
  • Malingering

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 CodePOA Reason for CodeCMS will pay the CC/MCC DRG?
YDiagnosis was present at time of inpatient admission.YES
NDiagnosis was not present at time of inpatient admission.NO
UDocumentation insufficient to determine if the condition was present at the time of inpatient admission.NO
WClinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission.YES
1Unreported/Not used - Exempt from POA reporting. NO

Convert Z76.5 to ICD-9

  • V65.2 - Person feigning illness

Code Classification

  • Factors influencing health status and contact with health services (Z00–Z99)
    • Persons encountering health services in other circumstances (Z69-Z76)
      • Persons encountering health services in other circumstances (Z76)

Code History

  • FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016
    (First year ICD-10-CM implemented into the HIPAA code set)
  • FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020

Information for Patients


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, post-traumatic stress disorder, and phobias
  • Depression, bipolar disorder, and other mood disorders
  • Eating disorders
  • Personality disorders
  • 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]