Practice Management Alert

Hint: Don’t lean on SDoH just to help level up an encounter.

Beginning Oct. 1, 2023, there are some updates to the Z codes categorized, especially in the as social determinants of health (SDoH) category, which you can use to provide context or history for a patient’s condition or encounter.

Review the updates and then keep reading for some expert advice on using these new codes correctly.

Check Out New Family History Codes

ICD-10 is expanding Z83.71 (Family history of colonic polyps) into four more specific codes:

• Z83.710 (Family history of adenomatous and serrated polyps)
• Z83.711 (Family history of hyperplastic colon polyps)
• Z83.718 (Other family history of colon polyps)
• Z83.719 (Family history of colon polyps, unspecified)

“Family history codes are for use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease,” according to ICD-10-CM official guideline I.C.21.c.4.

Properly documenting a family history of colon polyps helps justify early and more frequent screenings, like colonoscopies, which may lead to early detection. Having the option to code a family history of the specific type of polyp helps paint a more detailed picture for the payer and future physicians. Documenting family history “gives the full clinical picture for this visit by identifying the other factors that could influence decision making,” says 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.

Note Caregiver Noncompliance Codes

In October 2022, ICD-10-CM 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 (Caregiver’s other noncompliance with patient’s medication regimen for other reason)
• Z91.A51 (Caregiver’s noncompliance with patient’s renal dialysis due to financial hardship)
• Z91.A58 (Caregiver’s noncompliance with patient’s renal dialysis for other reason)
• Z91.A91 (Caregiver’s noncompliance with patient’s other medical treatment and regimen due to financial hardship)
• Z91.A98 (Caregiver’s noncompliance with patient’s other medical treatment and regimen for other reason)

The more specific primary care patient medical records can be with these types of codes, which often reflect SDoH, the better healthcare providers can identify potential barriers of 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.

Report More Details Around Guardian Relationships

You’ll soon have more ways to report notable child-guardian relationships, thanks to the following new codes:

• 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-CM 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:

• Z63.3- (Absence of family member)
• Z63.4 (Disappearance and death of family member)
• Z63.5 (Disruption of family by separation and divorce)
• Z63.8 (Other specified problems related to primary support group)
• Z63.7- (Other stressful life events affecting family and household)

Note: Along similar lines of child welfare, ICD-10-CM also added Z02.84 (Encounter for child welfare exam).

Report SDoH Responsibly

Some coders may feel pressured to use SDoH codes as evidence for increasing the level of evaluation and management (E/M) service for an encounter.

Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMCSC, CMCS, ACS-CA, SCP-CA, owner of Terry Fletcher Consulting Inc. and consultant, auditor, educator, author, and podcaster at Code Cast, in Laguna Niguel, California, says that this isn’t how SDoH codes should be used.

For example, if a provider realizes that a patient isn’t meeting treatment goals with a particular medication and dosage because the patient cannot afford the prescribed dose and is choosing to take only half every day, reporting Z91.120 (Patient’s intentional underdosing of medication regimen due to financial hardship) is crucial to accurately portraying that patient’s condition.

However, if a provider sees a teenager for a skin condition and headaches, and observes that the teen seems anxious or depressed, and wants to report Z55.3 (Underachievement in school), Z55.4 (Educational maladjustment and discord with teachers and classmates), Z55.9 (Problems related to education and literacy, unspecified) as context to the general teenage experience, reporting such SDoH codes probably cannot pass muster.

“Unless there’s a link between the rash and headache to not meeting school goals, and it’s clearly stated within the record, not just incidental findings in a conversation, you can’t include that,” Fletcher says.

Top tip: If you’re stumped on figuring out when including a SDoH might be appropriate, ask whether the respective factor or situation affected the patient’s access to care, Fletcher says. In the teenager example, using a SDoH code would represent the teenager’s experiences at school as having prevented them from accessing care.

Using SDoH codes can have a wide or lasting impact, too. “Make sure the patient knows it’s going to fall them around, because it’s going to be reported to their payer,” Fletcher warns.