Otolaryngology Coding Alert

And take note of the updated verbiage in the SDoH guideline.

Over the past few years, awareness and understanding of the importance of identifying and addressing health-related social needs in healthcare settings have grown, so 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 nearly 400 new diagnosis codes you’ll be able to report 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, this one’s for you.

Understand the Breadth of Z Code Utility

Before diving into what’s new, let’s review the importance of the codes in Chapter 21. As you know, Z codes capture information that significantly impacts patient care and health outcomes but are not in themselves a current illness or injury. Reporting these codes helps to:

• Support evaluation and management (E/M) coding
• Justify medical necessity
• Paint a complete picture of the patient’s circumstances
• Identify potential barriers to diagnosis and treatment
• Gather data on treatment efficacy and the true cost of care

Now that you’re up on some of the many very good reasons for using Z codes, let’s take a look at the changes on the horizon.

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.

Keep in mind: “When an SDoH affects the management of the patient’s problems, the risk measurement moves to at least moderate. The provider must tie the SDoH and how it impacts the patient’s problem(s) and what actions need to be taken to address the hurdles created by the SDoH,” notes Barbara J. Cobuzzi, MBA, CPC, COC, CPCO, CPC-P, CPC-I, CENTC, CMCS, of CRN Healthcare Solutions in Tinton Falls, New Jersey.

Prepare To Code for More Upbringing-Related Problems

Thanks to further expansion of the 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))

Analysis: 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.

Remember These Rules When Reporting SDoH

Per Section 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,” according to ICD-10 Official Guidelines.

Notice New SDoH Guideline Wording

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.”

Documentation is key: “Coders need to be aware of documentation in the record in an effort to capture and report these social determinants of health. Codes need supporting documentation that indicates a risk or concern by the practitioner,” emphasizes Chelsea Kemp, RHIT, CCS, COC, CDEO, CPMA, CRC, CCC, CEDC, CGIC, AAPC Approved Instructor, outpatient coding educator/auditor for Yale New Haven Health, New Haven, Connecticut.