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v1.0.0
ICD-10 Guide
ICD-10 CodesZ59.86

Z59.86

Financial insecurity

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/12/2025

Code Description

ICD-10 Z59.86 is a billable code used to indicate a diagnosis of financial insecurity.

Key Diagnostic Point:

Financial insecurity refers to the lack of sufficient financial resources to meet basic needs, which can significantly impact an individual's health status and access to healthcare services. This Z code is used to identify patients who may be experiencing financial difficulties that affect their ability to afford medications, transportation to healthcare appointments, or necessary preventive care. Financial insecurity can lead to increased stress, anxiety, and other mental health issues, which may further complicate existing health conditions. Preventive care and screenings may be neglected due to financial constraints, leading to poorer health outcomes. Healthcare providers should be aware of these social determinants of health and consider them when developing care plans. Addressing financial insecurity through community resources, social services, and patient education can improve health outcomes and encourage patients to seek necessary care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Varied definitions of financial insecurity across different populations.
  • Need for comprehensive documentation to support the diagnosis.
  • Potential overlap with other social determinants of health codes.
  • Impact on treatment plans and patient compliance.

Audit Risk Factors

  • Inadequate documentation of financial circumstances.
  • Failure to link financial insecurity to specific health outcomes.
  • Misuse of the code without clear evidence of financial impact on care.
  • Inconsistent application of the code across different encounters.

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation should include patient-reported financial difficulties, impact on medication adherence, and access to care.

Common Clinical Scenarios

Routine checkups where financial barriers affect preventive screenings or follow-up care.

Billing Considerations

Consideration of social determinants and their influence on patient health and treatment adherence.

Public Health

Documentation Requirements

Population-level data on financial insecurity and its correlation with health outcomes.

Common Clinical Scenarios

Epidemiological studies assessing the impact of financial insecurity on community health.

Billing Considerations

Focus on tracking health disparities and resource allocation.

Coding Guidelines

Inclusion Criteria

Use Z59.86 When
  • Z codes should be used when the financial insecurity is a significant factor influencing the patient's health status or healthcare utilization
  • It is important to sequence Z codes appropriately, often as secondary diagnoses, and to ensure that the primary diagnosis reflects the main reason for the encounter
  • Payer requirements may vary, so it is essential to verify coverage for Z code usage

Exclusion Criteria

Do NOT use Z59.86 When
No specific exclusions found.

Related CPT Codes

99401CPT Code

Preventive medicine counseling

Clinical Scenario

Used when counseling patients about financial resources and health management.

Documentation Requirements

Document the counseling session and its impact on health outcomes.

Specialty Considerations

Primary care providers should integrate financial counseling into routine visits.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding social determinants of health, including financial insecurity, which can lead to improved understanding and management of patient needs.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding social determinants of health, including financial insecurity, which can lead to improved understanding and management of patient needs.

Reimbursement & Billing Impact

financial insecurity, which can lead to improved understanding and management of patient needs.

Resources

Clinical References

  • •
    CDC Social Determinants of Health

Coding & Billing References

  • •
    CDC Social Determinants of Health

Frequently Asked Questions

When should Z59.86 be used?

Z59.86 should be used when financial insecurity is documented as impacting a patient's health status or access to care. It is important to provide supporting documentation that links financial issues to health outcomes.