Z91.151
BillablePatient's noncompliance with renal dialysis due to financial hardship
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Z91.151 an HCC code?
Yes. Z91.151 maps to Dialysis Status under the V24 model but is not retained in V28.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for Z91.151
For Z91.151 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed Z91.151 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Z91.151 is the ICD-10-CM diagnosis code for patient's noncompliance with renal dialysis due to financial hardship. A patient is not attending or completing their prescribed kidney dialysis treatments because they cannot afford the associated costs. Z91.151 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering persons with potential health hazards related to family and personal history and certain conditions influencing health status (z77-z99).
Under the older CMS-HCC V24 model, Z91.151 maps to Dialysis Status (HCC 134) with a community, non-dual, aged base RAF weight of 0.452. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
This code is specific to dialysis noncompliance due to financial barriers; dialysis is a life-sustaining treatment. Because Z91.151 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Z91.151 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code is specific to dialysis noncompliance due to financial barriers; dialysis is a life-sustaining treatment
- •Coordinate with social work and financial counseling to address barriers to dialysis access
Clinical Significance
This code identifies a critical barrier to life-sustaining treatment that significantly increases mortality risk and healthcare costs. Financial hardship causing dialysis noncompliance requires immediate social work intervention and may qualify patients for emergency financial assistance programs.
Documentation Requirements
- ✓Clear documentation of dialysis noncompliance
- ✓Specific identification of financial hardship as the cause
- ✓Evidence of patient's inability to pay for treatment
- ✓Documentation of missed or incomplete dialysis sessions
- ✓Social work assessment of financial barriers
- ✓Attempts to address financial obstacles
- ✓Impact on patient's health status
- ✓Alternative payment options explored