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Z55.2 ICD-10-CM Code: Failed school examinations

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 Excludes1

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 951 — OTHER FACTORS INFLUENCING HEALTH STATUS (MDC 23)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for Z55.2 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on Z55.2 itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from Z55

Coder workflow for Z55.2

MedCoder structured workflow — derived from this code’s own official record

Before you code Z55.2

  1. Confirm the reason for the encounter this Z code records: the circumstance it records. Check whether the code may be reported as first-listed or principal — some Z codes are limited to one position — and do not report a history or status code for a condition documented as current. Z code categories and their reporting positions (Guidelines I.C.21.c, I.C.21.c.15).

    Guide: Z codes as principal or first-listed diagnosis →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with Z55.2. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in Z55.2’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

Consider Z55.2. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The reason for the encounter
Whether the code records the encounter’s purpose, a status, or a history — and whether it may be first-listed (Guidelines I.C.21.c).

Official instructions as workflow

  • Excludes1 — check before selecting Z55.2(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with Z55.2: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    See the official tabular notes · Guidelines I.A.12.a

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition Z55.2 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Failed school examinations is a billable ICD-10-CM diagnosis code (Z55.2).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (2)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)

See Section I.B.14. for Z55-Z65 Persons with potential health hazards related to socioeconomic and psychosocial circumstances, documentation by clinicians other than the patient’s provider

Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)

For social determinants of health classified to chapter 21, such as information found in categories Z55-Z65, Persons with potential health hazards related to socioeconomic and psychosocial circumstances, code assignment may be based on medical record documentation from clinicians involved in the care of the patient who are not the patient’s provider since this information represents social information, rather than medical diagnoses. For example, coding professionals may utilize documentation of social information from social workers, community health workers, case managers, or nurses, if their documentation is included in the official medical record.

Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)

Social determinants of health codes are located primarily in these Z code categories: Z55 Problems related to education and literacy Z56 Problems related to employment and unemployment Z57 Occupational exposure to risk factors Z58 Problems related to physical environment Z59 Problems related to housing and economic circumstances Z60 Problems related to social environment Z62 Problems related to upbringing Z63 Other problems related to primary support group, including family circumstances Z64 Problems related to certain psychosocial circumstances Z65 Problems related to other psychosocial circumstances See Section I.B.14. Documentation by Clinicians Other than the Patient's Provider.

Verify Before Coding

  • Principal-diagnosis restriction. The Medicare Code Editor lists this code as unacceptable as a principal diagnosis: it describes a circumstance influencing health status rather than a current illness or injury being treated. It is valid as a secondary diagnosis.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name Z55.2 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 2 Excludes2 notes: Z72 — Problems related to lifestyle (via Z55.-), Z73 — Problems related to life management difficulty (via Z55.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 1 MS-DRG: DRG 951 (MDC 23).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):FAC019 — Socioeconomic/psychosocial factors.

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Principal diagnosis restriction (Medicare Code Editor)

Not acceptable as a principal diagnosis on an inpatient claim.

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Socioeconomic/psychosocial factors).

Z55.0 — Illiteracy and low-level literacy, Z55.1 — Schooling unavailable and unattainable, Z55.3 — Underachievement in school, Z55.4 — Educational maladjustment and discord with teachers and classmates, Z55.5 — Less than a high school diploma, Z55.6 — Problems related to health literacy, Z55.8 — Other problems related to education and literacy, Z55.9 — Problems related to education and literacy, unspecified, Z56.0 — Unemployment, unspecified, Z56.1 — Change of job, Z56.2 — Threat of job loss, Z56.3 — Stressful work schedule, Z56.4 — Discord with boss and workmates, Z56.5 — Uncongenial work environment, Z56.6 — Other physical and mental strain related to work, Z56.81 — Sexual harassment on the job, Z56.82 — Military deployment status, Z56.89 — Other problems related to employment, Z56.9 — Unspecified problems related to employment, Z57.0 — Occupational exposure to noise, +102 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Problem”, “Failure, failed”; these codes share that main term but sit in a different category of the Tabular List.

T86.5 — Complications of stem cell transplant (transplant, stem cell), T86.811 — Lung transplant failure (transplant, lung), T86.821 — Skin graft (allograft) (autograft) failure (transplant, skin), T86.831 — Bone graft failure (transplant, bone), T86.841 — Corneal transplant failure (transplant, cornea), T86.851 — Intestine transplant failure (transplant, intestine), T86.891 — Other transplanted tissue failure (transplant, pancreas), T86.92 — Unspecified transplanted organ and tissue failure (transplant), T88.4 — Failed or difficult intubation (intubation during anesthesia), T88.52 — Failed moderate sedation during procedure (sedationduring procedure), Z56.0 — Unemployment, unspecified (unemployment), Z56.1 — Change of job (employment, change of job), Z56.2 — Threat of job loss (unemployment, threatened), Z56.3 — Stressful work schedule (work schedule), Z56.4 — Discord with boss and workmates (employment, discord), Z56.5 — Uncongenial work environment (employment, environment), Z56.6 — Other physical and mental strain related to work (employment, stress NEC), Z56.81 — Sexual harassment on the job (employment, sexual harassment), Z56.89 — Other problems related to employment (occupational NEC), Z56.9 — Unspecified problems related to employment (employment), +230 more

Contextual Map

Every relationship of Z55.2 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run Z55.2 with these 2 related codes in Claim Check

Hierarchy

Referenced by Excludes2 notes

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 23 — Factors Influencing Health Status and Other Contacts with Health Services[MDC crossing]: “Factors Influencing Health Status and Other Contacts with Health Services — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1,235 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Failure, failed, examination, anxiety concerning (s)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Problem (with) (related to), failed examinations (school)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (9)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "Z55.2 — Failed school examinations." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/z55.2-failed-school-examinations

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Failed school examinations

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to Z55.2 in its code family, with their registry titles.

View all codes in the Z55 family