If your practice is like most, you’ve been busily working to add the 2023 ICD-10-CM codes to your electronic health records and superbills to prepare for the Oct. 1, 2022 implementation date. But one area that many practices may not have spent much time absorbing involves the ICD-10 Z codes that are new this year. And if you don’t know them, you could be risking your reimbursement.
Here’s why: Along with the primary ICD-10-CM categories, the codes in chapter 21 (“Factors Influencing Health Status and Contact With Health Services”) provide you with a way to tell insurers more about why you saw a patient. They can offer extra details to payers that are required to paint a full picture of an encounter, and in some cases, can be used as primary diagnosis codes.
This year, the ICD-10-CM updates include several important additions to the ICD-10 Z codes that are essential for every practice to know.
Eye New Codes for Long-Term Use of Medications
Among the most significant changes to the ICD-10 Z codes are over a dozen additions to Chapter 21 representing long-term use of specific medications. The number and types of medications that patients are taking daily can be significant, and some of these medications carry longer-term risks and should be identified so they can be more closely monitored and tracked.
The American Academy of Pediatrics (AAP) requested the expansion of this code set to capture more of these medications to better identify and monitor the risk and long-term outcomes, including the following new codes, among others:
- 61: Long term (current) use of immunomodulator
- 630: Long term (current) use of alkylating agent
- 631: Long term (current) use of antimetabolite agent
Example: Suppose a new patient presents to your practice with juvenile Crohn’s disease and you note that she has been on methotrexate for over a year to control her Crohn’s symptoms. You plan to give the patient a vaccination booster outside of the standard pediatric schedule and you document that the patient is immunocompromised due to her methotrexate use. Although the most appropriate Crohn’s disease diagnosis code will probably be your primary diagnosis, you can add Z79.631 to the claim to denote the patient’s long-term use of methotrexate, which is an antimetabolite agent.
Check 3 New Social Determinants of Health Codes
Additional updates to Chapter 21 involve the addition of three new codes in the Social Determinants of Health category:
- 82: Transportation insecurity
- 86: Financial insecurity
- 87: Material hardship
These codes may become increasingly important as the Medicare Advantage program uses risk adjustment factor scores, so if a patient is experiencing financial insecurity, material hardship or transportation insecurity, it’s a good idea to add these Z codes to your claims, following the primary ICD-10 code representing the reason for the encounter.
Master the New Personal History of Congenital Anomaly Codes
Some infants are born with congenital conditions, which are later corrected medically. However, even though the acute problem is resolved, many patients continue to face issues throughout their lives due to having been born with the condition. Therefore, the Children’s Hospital Association (CHA) requested new ICD-10-CM codes for selected digestive and musculoskeletal system congenital conditions, resulting in the debut of nine new codes, as follows:
- 61: Personal history of (corrected) necrotizing enterocolitis of newborn
- 68: Personal history of other (corrected) conditions arising in the perinatal period
- 731: Personal history of (corrected) tracheoesophageal fistula or atresia
- 732: Personal history of (corrected) persistent cloaca or cloacal malformations
- 760: Personal history of (corrected) congenital diaphragmatic hernia or other congenital diaphragm malformations
- 761: Personal history of (corrected) gastroschisis
- 762: Personal history of (corrected) prune belly malformation
- 763: Personal history of other (corrected) congenital abdominal wall malformations
- 768: Personal history of other specified (corrected) congenital malformations of integument, limbs and musculoskeletal system
Example: Suppose a child is born with congenital diaphragmatic hernia and later develops pulmonary hypertension, requiring regular pulmonology visits. The pulmonologist would use the pulmonary hypertension as the primary diagnosis code, but would add Z87.760 to show insurers a clearer picture of the infant’s health status, answering the question of the complexity of the patient’s case.
To get a firm grasp of all of the new ICD-10-CM code changes and guideline shifts that hit Oct. 1, 2023, check out the online training session, Don’t Miss the Oct. 1 Deadline: New 2023 ICD-10-CM Codes, presented by Kim Huey MJ, CHC, CPC, CCS-P, PCS, CPCO. During the 60-minute training, you’ll find out which new codes are debuting, which are being deleted, and which guideline updates you must know to submit clean claims.
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