Come April 1, coders will have additional code options to further capture social determinants of health (SDOH) and abuse and neglect, as CDC released upcoming changes to both the code set and official guidelines on Jan. 9.
The new changes include 42 code additions, seven deletions and one code revision. The additions were made to Chapters 19, 20 and 21 of the Tabular. All changes will go into effect April 1, which should give practices time to train staff and update their coding systems.
New SDOH code Z55 (Problems related to education and literacy) is among the code additions.
Also added are codes to update category Y07 in order to better align verbiage related to critical perpetrator of abuse external cause codes with that of current CDC core data collection elements and literature related to patient maltreatment and neglect — including elder abuse.
For example, you’ll find new code Y07.44 (Child [biological, step, in-law, foster, adopted], perpetrator of maltreatment, and neglect). The series of new Y codes also add an option for “non-binary partner,” as in code Y07.050 (Non-binary partner, current, perp of maltreat and neglect).
Chapter 19 will include a slate of new codes pertaining to “financial abuse” of adults and children. For example, the April update brings codes T74.A1XA (Adult financial abuse, confirmed, initial encounter) and T74.A2XA (Child financial abuse, confirmed, initial encounter). Similar codes were added for suspected financial abuse.
Some codes were also deleted to make more specific code options available. For instance, Z59.1 (Inadequate housing) will be invalidated and replaced with expanded code options:
- Z59.10 (Inadequate housing, unspecified).
- Z59.11 (Inadequate housing environmental temperature).
- Z59.12 (Inadequate housing utilities).
- Z59.19 (Other inadequate housing).
The one revision, made to Z59.87 (Material hardship), is an expansion of its description “Material hardship due to limited financial resources, NEC.”
Check out guideline changes
The ICD-10-CM Official Guidelines have been expanded to provide more examples in the SDOH section. For example, If a patient who lives alone suffers an injury that temporarily impacts their ability to perform activities of daily living, it would be appropriate to include 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,” the new guidelines explain.
The guidelines also now instruct coders that it would be appropriate to assign Z59.41 (Food insecurity), if the record indicates the patient has concerns about “access and availability of food” or a code from subcategory Z59.0- (Homelessness) for a patient experiencing homelessness.
The revisions emphasize that the SDOH should connect directly to the episode of care.
Below find a fuller description of changes to the guidelines, including updated directions for assigning SDOH codes (see changes in bold):
“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).”