2027 ICD-10-CM Diagnosis Code Z76.5Malingerer [conscious simulation]
Z76.5 is a billable ICD-10-CM diagnosis code for malingerer [conscious simulation]. 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 exempt from POA reporting. Coders also document this condition as drug seeking behavior. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Other specified status.
Code Identity
Code Classification
Present on Admission (POA)Billing
Z76.5 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Persons encountering health services in other circumstances (Z69-Z76).
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Drug seeking behavior
- Feigning of symptoms
- Malingering
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to Z76.5: its own notes plus those printed at 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.
- Person feigning illness (with obvious motivation)
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
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 Z76.5, its category, or a range that includes it.
Excludes2 3
These codes carry an Excludes2 note naming Z76.5: 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.
drug seeking Z76.5
Disorder (of) See Also: Disease;
Feigned illness Z76.5
Malingerer, malingering Z76.5
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Mental Disorders
Mental disorders (or mental illnesses) are conditions that affect your thinking, feeling, mood, and behavior. They may happen over a short period of time or come and go. Some can be chronic (long-lasting). They can affect your ability to relate to others and function each day..
The full article covers:
- What are mental disorders?
- What are some types of mental disorders?
- What causes mental disorders?
- Who is at risk for mental disorders?
- How are mental disorders diagnosed?
- What are the treatments for mental disorders?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert Z76.5 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About Z76.5Overview
What is the ICD-10 code for malingerer [conscious simulation]?
The ICD-10-CM code for malingerer [conscious simulation] is Z76.5 (sometimes written as Z765). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is Z76.5 (Persons encountering health services in other circumstances) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report malingerer [conscious simulation] on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does Z76.5 group to?
When malingerer [conscious simulation] is the principal diagnosis on an inpatient stay, it groups to MS-DRG 951 (other Factors Influencing Health Status), which carries a relative weight of 0.5574. Higher weights mean higher Medicare reimbursement.
Is Z76.5 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 malingerer [conscious simulation] on inpatient claims. The code appears in the Persons encountering health services in other circumstances (Z69-Z76) range of the CMS exempt list.
Can Z76.5 be reported with a code from F68.1?
Not as a rule. The Excludes1 note on Z76.5 lists "factitious disorder (F68.1-, F68.A)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
