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Z76.5 ICD-10-CM Code: Malingerer [conscious simulation]

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

Coding at a Glance

Tabular directives
1 inclusion term · 2 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 Z76.5 in the official ICD-10-CM tabular list, quoted as published.

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

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Person feigning illness (with obvious motivation)

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).

Coder workflow for Z76.5

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

Before you code Z76.5

  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 Z76.5. 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 Z76.5’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.

    ReviewF68.1, F68.A

Consider Z76.5. 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 Z76.5(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with Z76.5: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareF68.1, F68.A

    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 Z76.5 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).

ReviewF68.1, F68.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

Malingerer [conscious simulation] is a billable ICD-10-CM diagnosis code (Z76.5).

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 (8)

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)

Z76.3 Healthy person accompanying sick person Z76.4 Other boarder to healthcare facility Z76.5 Malingerer [conscious simulation] Z91.1- Patient’s noncompliance with medical treatment and regimen Z91.A- Caregiver’s noncompliance with patient’s medical treatment and regimen Z91.B Personal risk factor of exposure to diethylstilbestrol Z91.83 Wandering in diseases classified elsewhere Z91.84- Oral health risk factors Z91.89 Other specified personal risk factors, not elsewhere classified

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

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 Z76.5 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 3 Excludes2 notes: F44 — Dissociative and conversion disorders, F45 — Somatoform disorders, F68.1 — Factitious disorder imposed on self.

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):FAC025 — Other specified status (default).

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

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Other specified status).

Z75.0 — Medical services not available in home, Z75.1 — Person awaiting admission to adequate facility elsewhere, Z75.2 — Other waiting period for investigation and treatment, Z75.3 — Unavailability and inaccessibility of health-care facilities, Z75.4 — Unavailability and inaccessibility of other helping agencies, Z75.5 — Holiday relief care, Z75.8 — Other problems related to medical facilities and other health care, Z75.9 — Unspecified problem related to medical facilities and other health care, Z76.3 — Healthy person accompanying sick person, Z76.4 — Other boarder to healthcare facility, Z76.81 — Expectant parent(s) prebirth pediatrician visit, Z76.82 — Awaiting organ transplant status, Z77.010 — Contact with and (suspected) exposure to arsenic, Z77.011 — Contact with and (suspected) exposure to lead, Z77.012 — Contact with and (suspected) exposure to uranium, Z77.018 — Contact with and (suspected) exposure to other hazardous metals, Z77.020 — Contact with and (suspected) exposure to aromatic amines, Z77.021 — Contact with and (suspected) exposure to benzene, Z77.028 — Contact with and (suspected) exposure to other hazardous aromatic compounds, Z77.090 — Contact with and (suspected) exposure to asbestos, +232 more

Same Index main term, other category

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

Z72.53 — High risk bisexual behavior (life-style, high-risk sexual behavior, bisexual), Z72.6 — Gambling and betting (life-style, gambling), Z72.810 — Child and adolescent antisocial behavior (antisocial, child or adolescent), Z72.811 — Adult antisocial behavior (antisocial, adult), Z72.821 — Inadequate sleep hygiene (sleep-incompatible), Z72.89 — Other problems related to lifestyle (self-damaging), Z72.9 — Problem related to lifestyle, unspecified (life-style), Z73.1 — Type A behavior pattern (type A pattern), Z73.89 — Other problems related to life management difficulty (life-management, specified NEC), Z73.9 — Problem related to life management difficulty, unspecified (life-management), Z74.09 — Other reduced mobility (impaired mobility), Z74.2 — Need for assistance at home and no other household member able to render care (living, without, person able to render necessary care), Z74.8 — Other problems related to care provider dependency (care, provider dependency, specified NEC), Z74.9 — Problem related to care provider dependency, unspecified (care, provider dependency), Z75.1 — Person awaiting admission to adequate facility elsewhere (on waiting list), Z75.8 — Other problems related to medical facilities and other health care (health care, specified NEC), Z75.9 — Unspecified problem related to medical facilities and other health care (health care), Z78.9 — Other specified health status (influencing health status NEC), Z91.81 — History of falling (falling), Z91.89 — Other specified personal risk factors, not elsewhere classified (personal hygiene), +107 more

Contextual Map

Every relationship of Z76.5 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 Z76.5 with these 4 related codes in Claim Check

Hierarchy

Excludes1

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

  • Behavior, drug seeking[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Conscious simulation (of illness)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Disorder (of), feigned (with obvious motivation)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Feigned illness[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Malingerer, malingering[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Person (with), feigning illness[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Problem (with) (related to), behavioral (adult), drug seeking[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Simulation, conscious (of illness)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (10)

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. "Z76.5 — Malingerer [conscious simulation]." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/z76.5-malingerer-conscious-simulation

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Malingerer [conscious simulation]

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 Z76.5 in its code family, with their registry titles.

View all codes in the Z76 family