Z76.5

Z76.5: Malingerer [conscious simulation]

Billable / specific codeICD-10-CMPOA exempt

Z76.5 is a billable, specific ICD-10-CM code for malingerer [conscious simulation]. It is valid for submission on a claim.

Check Z76.5 with the rest of the claim: free scrubber

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

factitious disorder (F68.1-, F68.A)
peregrinating patient (F68.1-)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Person feigning illness (with obvious motivation)

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

Z76.5 is named in 3 Medicare coverage policies: 3 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A56551Billing and Coding: Visual Fields Testing
A56799Billing and Coding: Visual Fields Testing
A57434Billing and Coding: Vestibular and Audiologic Function Studies

Alphabetic index entries that lead here

Conscious simulation(of illness)
Feigned illness
Malingerer, malingering
Simulation, conscious(of illness)
Behavior›drug seeking
Disorder›feigned(with obvious motivation)
Person›feigning illness
Problem›behavioral›drug seeking

Code history

Unchanged in every release from FY2024 to FY2027.