Posted January 28, 2023
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 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 |
| 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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