With recent efforts to capture Social Determinants of Health and its impact on patient outcomes, starting April 1, 2023, 42 new codes will be added to the ICD-10-CM with 9 of those addressing issues like inadequate housing, health literacy, and personal history of abuse. These changes are part of a broader set of updates, including new codes, revisions, and guideline changes.
New SDoH Codes
Among the code additions is the new SDoH code Z55 (Problems related to education and literacy).
Some codes were also deleted to make more specific options available, such as replacing Z59.1 (Inadequate housing) with the following more expanded codes:
- Z59.10 (Inadequate housing, unspecified)
- Z59.11 (Inadequate housing environmental temperature)
- Z59.12 (Inadequate housing utilities)
- Z59.19 (Other inadequate housing)
See the full list of new coding and guideline changes from the Centers for Disease Control and Prevention (CDC) – with the 9 new SDoH codes highlighted – at the end of this article.
More Changes
There are also changes to codes for abuse. These include updates to category Y07 to better match current CDC data collection elements and literature on patient maltreatment and neglect, such as the addition of codes Y07.44 (Child [biological, step, in-law, foster, adopted], perpetrator of maltreatment, and neglect) and Y07.050 (Non-binary partner, current, perp of maltreat and neglect). Chapter 19 also has new codes for financial abuse, including T74.A1XA (Adult financial abuse, confirmed, initial encounter) and T74.A2XA (Child financial abuse, confirmed, initial encounter). Suspected financial abuse codes have also been added.
Furthermore, code Z91.14 (patient’s other noncompliance with medication regimen) has been deleted and replaced with more detailed codes to better capture the specific reasons behind the patient’s non-compliance.
Essential Points to Keep in Mind
The ICD-10-CM Official Guidelines have been expanded to provide more examples in the SDoH section. To assign SDoH codes, use the documented social problems, conditions, or risk factors in the patient’s medical record. Assign as many SDoH codes as necessary to fully describe the episode of care.
For instance, a patient living alone who suffers an injury temporarily affecting their ability to do daily activities can be assigned code Z60.2 (Problems related to living alone). However, if there’s no documentation of risk or unmet need for assistance, this code should not be used. If the patient expressed concerns about food access and availability, assign code Z59.41 (Food insecurity). If the patient is homeless, use a code from subcategory Z59.0- (Homelessness). The changes highlight the importance of directly connecting the SDOH to the episode of care.
Ensure that your agency determines how the seven deleted codes may impact episodes of care and update any affected claims with the appropriate code by April 1, 2023. If a claim is returned due to an invalid diagnosis code, correct it with the updated diagnosis code and resubmit it for payment.
Effective Care through Accurate SDoH Capture and Staff Training
It is crucial to capture SDoH accurately in patient documentation to improve patient outcomes. This includes training staff to document and assign appropriate codes properly. Coders must be aware of any changes, including the recent SDoH code adjustments, to ensure that they assign the appropriate codes for each episode of care. By accurately capturing SDoH and training staff, healthcare providers can better understand their patients and provide more effective care.
To view the full changes coming in April, visit https://www.cdc.gov/nchs/icd/Comprehensive-Listing-of-ICD-10-CM-Files.htm.
Added codes:
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
New SDoH Codes
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: | Equivalent Specific Code Options: |
| Y07.01 Husband, perpetrator of maltreatment and neglect | Y07.010 Husband, current, perpetrator of maltreatment and neglectY07.011 Husband, former, perpetrator of maltreatment and neglect |
| Y07.02 Wife, perpetrator of maltreatment and neglect | Y07.020 Wife, current, perpetrator of maltreatment and neglectY07.021 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 neglectY07.031 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 neglectY07.041 Female partner, former, perpetrator of maltreatment and neglect |
| Z59.1 Inadequate housing | Z59.10 Inadequate housing, unspecifiedZ59.11 Inadequate housing environmental temperatureZ59.12 Inadequate housing utilitiesZ59.19 Other inadequate housing |
| Z91.14 Patient’s other noncompliance with medication regimen | Z91.141 Patient’s other noncompliance with medication regimen due to financial hardshipZ91.148 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 hardshipZ91.158 Patient’s noncompliance with renal dialysis for other reason |
Revisions to Code Description:
Z59.87 Material hardship due to limited financial resources, NEC
