Ophthalmology and Optometry Coding Alert

And review the revamped SDoH guideline.

As you know, Z codes capture information that significantly impacts patient care and health outcomes. Reporting these codes helps to paint a complete picture of the patient’s circumstances, justify medical necessity, and gather data on treatment efficacy and the true cost of care. Given the growing understanding of the importance of identifying and addressing health-related social needs in healthcare settings, it’s no surprise that ICD-10 Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99) is constantly expanding.

Among the hundreds of codes going into effect starting Oct. 1, 2023, are a handful of Z codes, including several social determinants of health (SDoH) codes, that you’ll want in your coding arsenal. If you’d like to know what to expect, read on.

Check These New Caregiver Noncompliance Codes

In October 2022, ICD-10 added six Z91.A- codes to address caregiver noncompliance, and October 2023 will see an even more granular code selection. This update affects Z91.A4 (Caregiver’s other noncompliance with patient’s medication regimen), Z91.A5 (Caregiver’s noncompliance with patient’s renal dialysis), and Z91.A9 (Caregiver’s noncompliance with patient’s other medical treatment and regimen). These codes will soon be the parent codes to the following:

• Z91.A41 (Caregiver’s other noncompliance with patient’s medication regimen due to financial hardship)
• Z91.A48 (… for other reason)
• Z91.A51 (Caregiver’s noncompliance with patient’s renal dialysis due to financial hardship)
• Z91.A58 (… for other reason)
• Z91.A91 (Caregiver’s noncompliance with patient’s other medical treatment and regimen due to financial hardship)
• Z91.A98 (… for other reason)

The more specific medical records can be with these types of codes, which often reflect SDoH, the better healthcare providers can identify potential barriers to effective treatment. These codes also help to document situations that can protect providers legally. For example, if a patient’s condition worsens due to noncompliance, having these codes documented can show that the provider did their due diligence.

Prepare To Code for More Upbringing-Related Problems

Thanks to further expansion of the social determinants of health (SDoH) code group (Z55-Z65), you’ll soon have more ways to report notable child-guardian relationships. The new codes include:

• Z62.23 (Child in custody of non-parental relative)
• Z62.24 (Child in custody of non-relative guardian)
• Z62.823 (Parent-step child conflict)
• Z62.83- (Non-parental relative or guardian-child conflict)
• Z62.831 (Non-parental relative-child conflict)
• Z62.832 (Non-relative guardian-child conflict)
• Z62.833 (Group home staff-child conflict)
• Z62.892 (Runaway (from current living environment))

Reporting problems related to the dynamics of child-guardian relationships offers valuable context to a variety of mental and physical health issues that may be present or arise in the future. The addition of codes such as these can help guide the development of a personalized care plan.

Coding alert: Notice that Z62.83-, while new, is a parent code and therefore not billable. Also take note that “in addition to expanding the number of codes in Z62.8- family, ICD-10 is adding a ‘Code also’ instruction applicable to all the codes under Z62.8-,” observes Kent Moore, senior manager for payment strategies at the American Academy of Family Physicians. The instruction advises to code also, if applicable:

• absence of family member (Z63.3-)
• disappearance and death of family member (Z63.4)
• disruption of family by separation and divorce (Z63.5)
• other specified problems related to primary support group (Z63.8)
• other stressful life events affecting family and household (Z63.7-)

Clinicians should be documenting SDoH and, in general, you should be coding them. Presently, “more attention is being drawn to patients’ social determinants of health,” says Carol Pohlig, BSN, RN, CPC, manager of coding and education at the University of Pennsylvania in Philadelphia. By accurately documenting SDoH, healthcare providers can better understand the factors affecting a patient’s health, leading to improved care management, resource allocation, and health outcomes.

Review 2024 SDoH Coding Rules and Guidelines

Before adding SDoH codes to the claim, be sure you’re familiar with the main ICD-10 guidelines that govern their use. Per I.B.14, codes in categories Z55-Z65 “should only be reported as secondary diagnoses.” Additionally, Z55-Z65 are some of the only codes in ICD-10 that you can report “based on medical record documentation from clinicians involved in the care of the patient who are not the patient’s provider.” That’s because “this information represents social information, rather than medical diagnoses,” as the guidelines go on to elaborate.

So, you can use documentation “from social workers, community health workers, case managers, or nurses, if their documentation is included in the official medical record,” and “patient self-reported documentation … to assign codes for social determinants of health, as long as the patient self-reported information is signed-off by and incorporated into the medical record by either a clinician or provider,” per ICD-10 Official Guidelines.

Note the updated verbiage: ICD-10 is also adding information to the SDoH guideline again, this time with two significant paragraphs, which you’ll find at the top of Section 1.C.21.c.17. Starting in October, the section will start off with a more detailed explanation of what SDoH means and instruction to 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.”

To clarify, the guideline offers several helpful examples including the following: “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.”