Z59.71Insufficient health insurance coverage

Z59.71 is the ICD-10-CM diagnosis code for insufficient health insurance coverage. It belongs to category Z59 (problems related to housing and economic circumstances), block Z55-Z65 (persons with potential health hazards related to socioeconomic and psychosocial circumstances) and chapter 21 (factors influencing health status and contact with health services). It is billable, so it can be reported on its own for dates of service from October 1, 2026 through September 30, 2027.

Within Z59.7 (insufficient social insurance and welfare support), Z59.71 is specifically for insufficient health insurance coverage. Related codes cover welfare support (Z59.72).

It is not a CC or MCC, so as a secondary diagnosis it doesn't change the MS-DRG severity level.

In MS-DRG v44.0, it is part of the grouping logic for DRG 951 (Other Factors Influencing Health Status, relative weight 0.5577), in MDC 23 (Factors Influencing Health Status and Other Contacts with Health Services), as a principal or secondary diagnosis. The DRG a claim lands in depends on the principal diagnosis, procedures and any CC/MCC secondary diagnoses.

It is not acceptable as the principal diagnosis for an inpatient stay; it may be reported as a secondary diagnosis.

It is exempt from present-on-admission (POA) reporting, so no POA indicator is required.

It was added in FY2025, effective October 1, 2024.