Action Steps for April 1
The CDC has released the upcoming changes to the ICD-10-CM code set that will take effect April 1, 2023. There are 42 new codes, 7 deleted codes and 1 code that has a description change.
Highlights of the April Code Changes
April 1 will bring additional codes to further identify Social Determinants of Health (SDoH). SDoH are conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life as defined by the CDC. By understanding an individual’s SDoH, agencies can deliver patient-specific care that can lead to improved outcomes.
Be Alert for Dates of Service Codes
Being familiar with the upcoming code changes that take effect April 1 will help ensure your agency prepares claims with the required updated codes. It is common after April 1 and October 1 of each year for agencies to receive claims that are returned to the provider due to invalid codes for the dates of service provided. Knowing the proper steps to correct the claims will help ensure a smooth process and save your agency valuable time.
For example, your agency received a claim with dates of service on or after April 1st that is returned to the provider indicating that code Z91.14 is invalid. Medical record documentation supports the patient’s noncompliance is due to financial hardship. Code Z91.14 should be corrected on the claim to Z91.141 and resubmitted.
Another common issue that can arise is that the current medical record documentation may not provide the specifics to determine the equivalent code. In this scenario, it will be necessary to query the provider to determine the appropriate equivalent code to update the claim.
Take Some Actions Now
Implementing the April 1 ICD-10-CM code set changes throughout your organization requires a winning strategy to ensure your claims submissions are compliant. Identify cases that have claims with codes that are changing and educate internal coders about the new code sets or coordinate with external partners who do your claims coding to ensure they are implemented throughout the organization. Here is a quick checklist to get you started on your journey:
- Discuss the new code sets with your EMR (Electronic Medical Record) vendor to assure compliance with the changes.
- Identify 1st and 2nd 30-day billing periods with dates of service on or after April 1st that contain the identified deleted codes and use the table below to determine the equivalent code that will be needed at claim submission.
- Some EMR vendors may be able to supply your agency with a patient impact report to help identify episodes that will be impacted from the code changes.
- For non-Medicare patients, determine if the private or commercial payor will be requiring new coding after April 1, 2023.
- Follow your internal processes for updating your claim codes. It is not necessary to change the codes on your prior POC (plan of care) or OASIS assessments.
- Still need help? Contact Corridor so we may help you with your plan to avoid reimbursement delays.
| Deleted Codes as of 4/1/2023 | Code Description | Equivalent Specific Code Options Effective 4/1/2023 |
| Y07.01 | Husband, perpetrator of maltreatment and neglect | Y07.010 Husband, current, perpetrator of maltreatment and neglect
Y07.011 Husband, former, perpetrator of maltreatment and neglect |
| Y07.02 | Wife, perpetrator of maltreatment and neglect | Y07.020 Wife, current, perpetrator of maltreatment and neglect
Y07.021 Wife, former, perpetrator of maltreatment and neglect |
| Y07.03 | Male partner, perpetrator of maltreatment and neglect | Y07.030 Male partner, current, perpetrator of maltreatment and neglect
Y07.031 Male partner, former, perpetrator of maltreatment and neglect |
| Y07.04 | Female partner, perpetrator of maltreatment and neglect | Y07.040 Female partner, current, perpetrator of maltreatment and neglect
Y07.041 Female partner, former, perpetrator of maltreatment and neglect |
| Z59.1 | Inadequate housing | Z59.10 Inadequate housing, unspecified
Z59.11 Inadequate housing environmental temperature
Z59.12 Inadequate housing utilities
Z59.19 Other inadequate housing |
| Z91.14 | Patient’s other noncompliance with medication regimen | Z91.141 Patient’s other noncompliance with medication regimen due to financial hardship
Z91.148 Patient’s other noncompliance with medication regimen for other reason |
| Z91.15 | Patient’s noncompliance with renal dialysis | Z91.151 Patient’s noncompliance with renal dialysis due to financial hardship
Z91.158 Patient’s noncompliance with renal dialysis for other reason |
| Added Code Effective 4/1/2023 | Code Description |
| T74.A1XA | Adult financial abuse, confirmed, initial encounter |
| T74.A1XD | Adult financial abuse, confirmed, subsequent encounter |
| T74.A1XS | Adult financial abuse, confirmed, sequela |
| T74.A2XA | Child financial abuse, confirmed, initial encounter |
| T74.A2XD | Child financial abuse, confirmed, subsequent encounter |
| T74.A2XS | Child financial abuse, confirmed, sequela |
| T76.A1XA | Adult financial abuse, suspected, initial encounter |
| T76.A1XD | Adult financial abuse, suspected, subsequent encounter |
| T76.A1XS | Adult financial abuse, suspected, sequela |
| T76.A2XA | Child financial abuse, suspected, initial encounter |
| T76.A2XD | Child financial abuse, suspected, subsequent encounter |
| T76.A2XS | Child financial abuse, suspected, sequela |
| Y07.010 | Husband, current, perpetrator of maltreatment and neglect |
| Y07.011 | Husband, former, perpetrator of maltreatment and neglect |
| Y07.020 | Wife, current, perpetrator of maltreatment and neglect |
| Y07.021 | Wife, former, perpetrator of maltreatment and neglect |
| Y07.030 | Male partner, current, perpetrator of maltreatment and neglect |
| Y07.031 | Male partner, former, perpetrator of maltreatment and neglect |
| Y07.040 | Female partner, current, perpetrator of maltreatment and neglect |
| Y07.041 | Female partner, former, perpetrator of maltreatment and neglect |
| Y07.050 | Non-binary partner, current, perpetrator of maltreatment and neglect |
| Y07.051 | Non-binary partner, former, perpetrator of maltreatment and neglect |
| Y07.44 | Child, perpetrator of maltreatment and neglect |
| Y07.45 | Grandchild, perpetrator of maltreatment and neglect |
| Y07.46 | Grandparent, perpetrator of maltreatment and neglect |
| Y07.47 | Parental sibling, perpetrator of maltreatment and neglect |
| Y07.54 | Acquaintance or friend, perpetrator of maltreatment and neglect |
| Z55.6 | Problems related to health literacy |
| Z58.81 | Basic services unavailable in physical environment |
| Z58.89 | Other problems related to physical environment |
| Z59.10 | Inadequate housing, unspecified |
| Z59.11 | Inadequate housing environmental temperature |
| Z59.12 | Inadequate housing utilities |
| Z59.19 | Other inadequate housing |
| Z62.814 | Personal history of child financial abuse |
| Z62.815 | Personal history of intimate partner abuse in childhood |
| Z91.141 | Patient’s other noncompliance with medication regimen due to financial hardship |
| Z91.148 | Patient’s other noncompliance with medication regimen for other reason |
| Z91.151 | Patient’s noncompliance with renal dialysis due to financial hardship |
| Z91.158 | Patient’s noncompliance with renal dialysis for other reason |
| Z91.413 | Personal history of adult financial abuse |
| Z91.414 | Personal history of adult intimate partner abuse |
| Z91.148 | Patient’s other noncompliance with medication regimen for other reason |
| Z91.151 | Patient’s noncompliance with renal dialysis due to financial hardship |
| Z91.158 | Patient’s noncompliance with renal dialysis for other reason |
| Z91.413 | Personal history of adult financial abuse |
| Z91.414 | Personal history of adult intimate partner abuse |
| Revisions to code description Effective 4/1/2023 | Code Description |
| Z59.87 Material hardship | Material hardship due to limited financial resources, NEC |
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