Is Z76.5 a billable ICD-10-CM code?

Yes. Z76.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does Z76.5 sit in the tabular list?

Factors influencing health status and contact with health services (Z00-Z99), in the block Persons encountering health services in other circumstances (Z69-Z76).

What cannot be coded together with Z76.5?

Z76.5 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

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.

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

Z76.5 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

Z76.5 is named in 3 Medicare coverage policies — 3 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

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

How Z76.5 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to Z76.5.

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

Related codes at this level

Codes that share Z76. If Z76.5 is not quite right, the correct code is usually one of these.

Questions about Z76.5

Is Z76.5 a billable ICD-10-CM code?: Yes. Z76.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does Z76.5 sit in the tabular list?: Factors influencing health status and contact with health services (Z00-Z99), in the block Persons encountering health services in other circumstances (Z69-Z76).
What cannot be coded together with Z76.5?: Z76.5 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.