F68.A vs Z76.5
F68.A and Z76.5 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
F68.A
Factitious disorder imposed on another
Billable
- Chapter 5
- Mental, Behavioral and Neurodevelopmental disorders
- Section
- F60-F69
Use when the record says
- Factitious disorder by proxy
- Münchausen's by proxy
Indexed under
- Disorder › factitious › by proxy (of)
- Disorder › factitious › imposed on another (of)
Z76.5
Malingerer [conscious simulation]
Billable
- Chapter 21
- Factors influencing health status and contact with health services
- Section
- Z69-Z76
Use when the record says
- Person feigning illness (with obvious motivation)
Indexed under
- Conscious simulation (of illness)
- Feigned illness
- Malingerer, malingering
- Simulation, conscious (of illness)
- Behavior › drug seeking
These two codes sit in different chapters of the Tabular List, which is usually the clearest signal that they describe different underlying processes rather than different degrees of the same one.
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027