2027 ICD-10-CM Diagnosis Code Z91.A51Caregiver's noncompliance with patient's renal dialysis due to financial hardship
Z91.A51 is a billable ICD-10-CM diagnosis code for Caregiver's noncompliance with patient's renal dialysis due to financial hardship. 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. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Other specified status.
Z91.A51 no longer risk-adjusts for Medicare Advantage: it mapped to HCC 134 under the retired CMS-HCC V24 model through payment year 2025 but maps to no category in the live V28 model. It still risk-adjusts in the PACE (CMS-HCC V22) category 134, ESRD (V21) category 134, ESRD (V24) category 134, and RxHCC Part D (V08) category 261 for payment year 2027.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for Z91.A51.
Present on Admission (POA)Billing
Z91.A51 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 family and personal history and certain conditions influencing health status (Z77-Z99).
Medicare Risk Adjustment (HCC)Billing
Z91.A51 no longer risk-adjusts for Medicare Advantage: it maps to no payment category in the live CMS-HCC V28 model, although it still risk-adjusts in the other CMS models shown below.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to Z91.A51: its own notes plus those printed at Z91, block Z77-Z99, and Chapter 21. A note printed at a category, block or chapter applies to every code under it.
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.
Code Also
A second code may be needed to fully describe the condition; the note gives no sequencing direction.
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 Z91.A51, its category, or a range that includes it.
Excludes2 1
These codes carry an Excludes2 note naming Z91.A51: 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.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Code History & ChangesHistory
Replacement Z91.A51 replaces the following previously assigned code(s):
- Z91.A5 - Caregiver's noncompliance with patient's renal dialysis
Questions About Z91.A51Overview
Is Z91.A51 (Caregiver's noncompliance with patient's renal dialysis) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report Caregiver's noncompliance with patient's renal dialysis due to financial hardship on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does Z91.A51 group to?
On inpatient claims, Caregiver's noncompliance with patient's renal dialysis due to financial hardship 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 Z91.A51 be a principal diagnosis?
No. The Medicare Code Editor rejects this code as a principal diagnosis because Caregiver's noncompliance with patient's renal dialysis due to financial hardship describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.
Is Z91.A51 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 Caregiver's noncompliance with patient's renal dialysis due to financial hardship on inpatient claims. The code appears in the Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99) range of the CMS exempt list.
Does Z91.A51 risk-adjust for Medicare Advantage payment?
Not for Medicare Advantage. Z91.A51 mapped to HCC 134 in the retired CMS-HCC V24 model, which last determined payment in 2025, but it maps to no category in the live V28 model; see all codes that no longer risk-adjust. It still risk-adjusts in the PACE (CMS-HCC V22) category 134 (Dialysis Status), ESRD (V21) category 134 (Dialysis Status), ESRD (V24) category 134 (Dialysis Status), and RxHCC Part D (V08) category 261 (Dialysis Status, Including End Stage Renal Disease).
