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Z59: Prepare for New SDOH ICD-10-CM Codes Before April 1

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Z59: Prepare for New SDOH ICD-10-CM Codes Before April 1

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Social determinants of health

Your practice is finally getting the 2023 ICD-10-CM codes committed to memory and you’re settling into the latest CPT code updates—but hot on the heels of those changes comes a whole new crop of diagnosis codes, set to debut on April 1, 2023. Among the latest additions to ICD-10-CM are more than a dozen new social determinants of health (SDOH) codes, as well as added verbiage in the diagnosis coding guidelines that instruct you on how to accurately report these codes.

Reminder: If you aren’t submitting the most accurate CPT and ICD-10-CM codes on your claims, payers will deny your services, and you could be out thousands. That’s why it’s essential to stay up to date, not just at the end of the year, but by instituting mid-year updates that are introduced on a quarterly basis.

Get a feel for several new social determinants of health codes and guidelines prior to April 1 to continue collecting for your services.

Take Note of Updated SDOH Guidelines

Many coders rely on the ICD-10-CM Official Guidelines for Coding and Reporting to help them pinpoint the most accurate diagnosis codes to report on claims, along with rationale about why. That document has been updated with the changes going into effect on April 1 to reflect the rationale coders should use when selecting social determinants of health codes.

“Assign as many SDOH codes as are necessary to describe all of the social problems, conditions, or risk factors documented during the current episode of care,” the Guidelines indicate. You should report these codes only if they “influence a patient’s health,” new verbiage in the document indicates.

In other words, if a particular SDOH is in a patient’s record but doesn’t influence their health, you don’t need to report the code. For instance, if a 78-year-old patient worked a job as a teenager that exposed him to asbestos, you don’t have to report an occupational exposure to risk factors code (Z57.-) if the patient isn’t having any health problems that could have stemmed from asbestos exposure.

Check These New Codes

Effective April 1, you’ll have access to over a dozen new ICD-10-CM codes describing social determinants of health. Select examples are below of the codes that your practice may want to investigate:

  • Z55.6: Problems related to health literacy. For instance, if the patient has difficulty understanding medication instructions and therefore her heart condition is worse due to an inability to take medication as instructed, this code would apply, in addition to the code for the heart condition.
  • Z58.81: Basic services unavailable in physical environment. Suppose a patient can’t get internet or phone service in his geographic area because it’s not available there, and he therefore missed notifications about his appointments. The physician finds that the patient’s vasculitis worsened due to the missed appointments, and therefore should use this code on a claim (along with the vasculitis code) to show a full picture of the situation.
  • Z59.11: Inadequate housing environmental temperature. This code describes such situations as patients who don’t have air conditioning or heating, and that lack of temperature control affects their health. For instance, if excessive heat exacerbates a patient’s hypertension, you might consider reporting Z59.11 in addition to the high blood pressure code.
  • Z59.19: Other inadequate housing. Suppose a patient has a pest infestation that makes it impossible for her to keep wounds clean. In that case, the provider might report this code in addition to the wound or infection code.
  • Z91.151: Patient’s noncompliance with renal dialysis due to financial hardship. If a patient is unable to afford the copay for her dialysis and therefore skips the appointment, the provider might report this code in addition to the renal failure code.

It’s a good idea to research all of the new diagnosis codes so your practice is ready before April 1, 2023. That way, you can ensure that your claims are as accurate as possible and that you keep bringing in the cash that your practice deserves.

Want more information about the 2023 ICD-10-CM codes? Let coding expert Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO,  guide the way. During her one-hour online training session, “New 2023 ICD-10-CM Codes,” Kim will help you navigate the processes you’ll need to understand to collect for your claims this year.

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