New SDOH Codes Featured in CDC April 1 Changes to ICD-10-CM

New SDOH Codes Featured in CDC April 1 Changes to ICD-10-CM

Social Determinants of Health, or SDoH, affect patient outcomes and therefore it is important that they are accurately captured in patient documentation. Beginning April 1, nine SDoH codes will be added to the ICD-10-CM changes which include a total of 42 additional codes, seven deleted codes, and one code revision along with changes to the guidelines.

With the recent focus on social determinants of health (SDoH), nine of the 42 new codes will detail problems or risk factors related to issues such as health literacy, basic services unavailable in physical environment, inadequate housing, personal history of child financial abuse, and personal history of intimate partner abuse in childhood.

In addition to the coding changes, the Centers for Disease Control and Prevention updated the guidelines for assigning SDoH codes. The new guidelines (changes in bold) state:

“Social determinants of health (SDOH) codes describing social problems, conditions, or risk factors that influence a patient’s health should be assigned when this information is documented in the patient’s medical record. 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. For example, a patient who lives alone may suffer an acute injury temporarily impacting their ability to perform routine activities of daily living.

“When documented as such, this would support assignment of code Z60.2 (Problems related to living alone). However, merely living alone, without documentation of a risk or unmet need for assistance at home, would not support assignment of code Z60.2. Documentation by a clinician (or patient-reported information that is signed off by a clinician) that the patient expressed concerns with access and availability of food would support assignment of code Z59.41 (Food insecurity). Similarly, medical record documentation indicating the patient is homeless would support assignment of a code from subcategory Z59.0-(Homelessness).”

Other diagnosis changes include deletion of code Z91.14 (patient’s other noncompliance with medication regimen) which was replaced with the creation of more specific codes to help capture the most appropriate reasoning behind the patient’s non-compliance.

It will be important for your agency to determine which episodes of care will be impacted by any of the seven deleted codes to ensure claims are updated with the appropriate code effective April 1, 2023. If your agency receives a claim that has been returned to provider for an invalid diagnosis code related to the coding changes, the agency should correct the claim with the updated diagnosis code and resubmit it for payment.

A full list of the CDC coding and guideline changes set to take place April 1 are provided here for your convenience.

 

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

 

 

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 temperatureZ59.12 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

 

Revisions to code description Effective 4/1/2023 Code Description
Z59.87 Material hardship due to limited financial resources, NEC

 

You Can Go to the Source

The Center for Disease Control and Prevention (CDC) rules and regulations require constant vigilance. Of course, you can reach out to us at Corridor for guidance on implementing coding updates and for more information on the important changes that impact Social Determinants of Health. In the meantime, here is the link for the reference materials regarding the new SDOH codes.

Source: https://www.cdc.gov/nchs/icd/Comprehensive-Listing-of-ICD-10-CM-Files.htm

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