Podiatry Coding & Billing Alert

Hint: You’ll gain a new transportation insecurity Z code.

The Centers for Medicare & Medicaid Services (CMS) recently released the new ICD-10-CM 2023 codes. You won’t see any podiatry-specific codes this year, but you’ll have plenty new options to look through.

Learn more to get your podiatry practice ready for these codes, which will go into effect Oct. 1, 2022.

Pinpoint New Poisoning Codes

ICD-10-CM 2023 will add some new T codes. T codes encompass injury, poisoning, and other consequences of external causes.

You should report the following codes for poisoning by, adverse effect of, and underdoing of methamphetamines:

• T43.651X (Poisoning by methamphetamines accidental (unintentional)). Note: This code also includes poisoning by methamphetamines NOS.
• T43.652X (Poisoning by methamphetamines intentional self-harm)
• T43.653X (Poisoning by methamphetamines, assault)
• T43.654X (Poisoning by methamphetamines, undetermined)
• T43.655X (Adverse effect of methamphetamines)
• T43.656X (Underdosing of methamphetamines)

Don’t miss: With all of the above codes, you must add a 7th character to indicate the type of patient encounter. Your choices are as follows:

• A — Initial
• D — Subsequent
• S — Sequela

Mark Down New Z Options

You will see numerous new Z codes in 2023, including but not limited to the following:

• Z59.82 (Transportation insecurity). Note: This code will include excessive transportation time, inaccessible transportation, inadequate transportation, lack of transportation, unaffordable transportation, unreliable transportation, and unsafe transportation.
• Z59.86 (Financial insecurity). Note: This code will also include bankruptcy, burdensome debt, economic strain, financial strain. money problems, running out of money, and unable to make ends meet.
• Z59.87 (Material hardship). Note: This code will also include material deprivation, unable to obtain adequate childcare, unable to obtain adequate clothing, unable to obtain adequate utilities, and unable to obtain basic needs.
• Z91.110 (Patient’s noncompliance with dietary regimen due to financial hardship)
• Z91.118 (Patient’s noncompliance with dietary regimen for other reason)
• Z91.119 (Patient’s noncompliance with dietary regimen due to unspecified reason)
• Z79.85 (Long-term (current) use of injectable non-insulin antidiabetic drugs)
• Z91.19- (Patient’s noncompliance with other medical treatment and regimen)
• Z91.A- (Caregiver’s noncompliance with patient’s medical treatment and regimen)
• Z91.A2- (Caregiver’s intentional underdosing of patient’s medication regimen)
• Z91.A3 (Caregiver’s unintentional underdosing of patient’s medication regimen)
• Z91.A4 (Caregiver’s other noncompliance with patient’s medication regimen)
• Z91.A5 (Caregiver’s noncompliance with patient’s renal dialysis)
• Z91.A9 (Caregiver’s noncompliance with patient’s other medical treatment and regimen)

Don’t miss: You will report Z codes, Z00- (Encounter for general examination without complaint, suspected or reported diagnosis) through Z99- (Dependence on enabling machines and devices, not elsewhere classified) for factors influencing health status and contact with health services. Z codes represent reasons for encounters.

Oftentimes physicians will not document Z codes, but they are a wealth of information, says Jeri L. Jordan, CPC, billing manager at Hampton Roads Foot and Ankle in Williamsburg, Virginia. There are some new codes coming out in October that every office can incorporate into their notes. For example, if your patient is not compliant with the physician’s medical treatment (say not changing a bandage or cleaning an ulcer), and it is causing the wound not to heal, it is important to use the Z code documenting this noncompliance.

Or suppose the physician has prescribed an oral anti-fungal, and the caregiver does not give it to the patient for whatever reason, Jordan adds. You should be using the Z code to document that the patient is not getting the medication. The Z code provides a history of why the patient is not improving.

Don’t Miss These Brand-New External Cause Codes

You will also see many new external cause codes in 2023, including but not limited to the following:

• V20.01 (Electric (assisted) bicycle driver injured in collision with pedestrian or animal in nontraffic accident)
• V21.01 (Electric (assisted) bicycle driver injured in collision with pedal cycle in nontraffic accident)
• V22.31 (Person boarding or alighting an electric (assisted) bicycle injured in collision with two- or three-wheeled motor vehicle)
• V23.41 (Electric (assisted) bicycle driver injured in collision with car, pick-up truck or van in traffic accident)
• V27.11 (Electric (assisted) bicycle passenger injured in collision with fixed or stationary object in nontraffic accident)

Coding tip: Although not nationally mandated, external cause codes V00- (Pedestrian conveyance accident) through Y99- (External cause status) can and should be used on your claims, when applicable.

There are no national requirements that mandate you to report external cause codes. However, providers are still encouraged to voluntarily report these codes because they “provide valuable data for injury research and evaluation of injury prevention strategies,” per the ICD-10 Official Guidelines for Coding and Reporting. Although external cause codes are not payment codes, they can add important supplemental information to your claims.