Prepare for new ICD-10-CM codes for social determinants of health that take effect April 1st
You may be accustomed to ICD-10-CM updates that take effect annually on October 1. However, did you know several changes actually go live much sooner—on April 1? More specifically, the April 2023 ICD-10-CM update includes 42 ICD-10-CM additions, seven deletions, and one revision. In this article, we’ll focus on the new codes, all of which pertain to social determinants of health (SDOH).
Why are SDOH codes important?
SDOH codes are important because they help medical practices address the many barriers and challenges that impact health outcomes. Some examples include poverty, food insecurity, transportation difficulty, and illiteracy. These barriers remain under the radar unless practices identify them through coded data and look for patterns and trends that affect population health. SDOH codes may also justify higher levels of evaluation and management codes, risk adjusted payment methodologies, and quality measures.
What are the changes that take effect April 1?
Following is a summary of new codes that convey important information about SDOH:
Confirmed or suspected financial abuse (S00-T88)
The April 2023 update includes 12 new codes that specify whether financial abuse concerns an adult or child and whether it’s an initial or subsequent encounter or a sequela.Maltreatment and neglect (V00-Y99)
There are 15 new codes that specify whether the perpetrator is a husband, wife, male partner, female partner, non-binary partner, child, grandchild, grandparent, parental sibling, acquaintance, or friend.Health literacy (Z55.6)
One new code denotes problems related to health literacy. Report it when patients can’t find, understand, or use information to make important decisions related to their health.Problems associated with the physical environment (Z58.81 and Z58.89)
Two new codes denote issues with the physical environment such as the absence of essential services or lack of sanitation in the patient’s home.Inadequate housing (Z59.10-Z59.12 and Z59.19)
The April 2023 update includes four new codes for inadequate housing related to utilities, environmental temperature, and more.History of abuse (Z62.814, Z62.815, Z91.413, and Z91.414)
Four new personal history codes capture child financial abuse, intimate partner abuse in childhood, adult financial abuse, and intimate partner abuse in childhood.Patient noncompliance with medication or renal dialysis (Z91.141, Z91.148, Z91.151, and Z91.158)
The April 2023 update includes four new codes that denote noncompliance due to financial hardship or other reasons.
ICD-10-CM coding guidelines for SDOH reporting
As medical practices review the 42 new ICD-10-CM codes that take effect April 1, they should also take a few moments to review the ICD-10-CM coding guidelines for SDOH reporting. Here are a few important points to remember:
Medical coders may assign codes for SDOH based on medical record documentation from clinicians who are not the patient’s provider.
Only report SDOH codes as secondary diagnoses.
Assign as many SDOH codes as are necessary to describe all of the patient’s social problems, conditions, or risk factors documented during the current episode of care.
Medical coders may use patient self-reported documentation to assign codes for SDOH as long as a clinician or provider signs off on and incorporates the patient self-reported information into the medical record.
How to prepare
Take the following steps to prepare for the April 2023 ICD-10-CM update:
Educate providers and staff about the new ICD-10-CM codes that take effect April 1.
Begin screening for relevant information as part of the SDOH screening process.
Review the updated ICD-10-CM coding guidelines that also take effect April 1 and alert providers and staff to new requirements.
Work with your EHR and practice management vendors to ensure the new codes are included in any drop-down menus as of April 1, 2023.
Conclusion
With the expansion of SDOH codes comes an opportunity for medical practices to capture this important information that affects health outcomes. Take the time to review the changes and how your practice can leverage them to improve patient care while simultaneously generating revenue. Learn how edgeMED can help and be sure to check the Healthy Snacks blog for more expert insights, best practices and industry trends.
