Primary Care Coding Alert

News You Can Use:

Catch a Glimpse of the New ICD-10 Z Codes

Published on Tue Jul 18, 2023

Also: review the benefits of documenting noncompliance.

As you know, Z codes capture information that significantly impacts patient care and health outcomes, justify medical necessity, and help identify regional health trends. That’s why ICD-10 Chapter 21: Factors influencing Health Status and Contact with Health Services (Z00-Z99) is constantly expanding.

Starting Oct. 1, 2023, 501 new codes go into effect, and among those 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.

Know the 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.

See Additions to 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 (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.

Prepare to Code For More Problems Related To Upbringing

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 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: