Primary Care Coding Alert

2022 ICD-10 revisions let you document housing, food insecurity and more.

You’ll find many of the 191 new codes that will be added to ICD-10 beginning on Oct. 1, 2021, in Chapter 21: Factors influencing health status and contact with health services. Among them are numerous codes that will enable you to document social determinants of health (SDoH) — the way social circumstances affect a patient’s health — in much greater detail.

But they’re not the only changes you’ll find in that chapter. Here’s what to expect from next year’s ICD-10.

Social Determinants of Health (1): Housing Insecurity

In their continuing efforts to facilitate documentation of SDoH, the Centers for Disease Control and Prevention (CDC) has added a number of new codes to the existing Z59.- (Problems related to housing and economic circumstances) codes.

Code Z59.0 (Homelessness) is now broken out to three codes:

• Z59.00 (Homelessness unspecified)
• Z59.01 (Sheltered homelessness), which the code’s synonyms tell you to use when a patient is “living in a shelter such as: motel, scattered site housing, temporary or transitional living situation” and
• Z59.02 (Unsheltered homelessness), which you will use for patients “residing in [a] place not meant for human habitation such as: abandoned buildings, cars, parks, sidewalk” or “residing on the street.”

Additionally, “the CDC has broken out Z59.8 (Other problems related to housing and economic circumstances) into a number of new codes. You will now be able to document when a patient’s health is affected by housing instability, but the patient is currently not homeless, by adding sixth characters to Z59.81- (Housing instability, housed),” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

So, you will now be able to report:

• Z59.811 (Housing instability, housed, with risk of homelessness)
• Z59.812 (Housing instability, housed, homelessness in past 12 months)
• Z59.819 (Housing instability, housed unspecified)

Synonyms for all the Z59.81- codes tell you that you can use them when a patient is dealing with problems due to a foreclosure on home loan, is past due on rent or mortgage, and/or has undergone unwanted multiple moves in the last 12 months. Confusingly, the CDC moved similar synonyms (“foreclosure on loan,” “isolated dwelling,” and “problems with creditors,”) that were originally assigned to what is now parent code Z59.8- to new code Z59.89 (Other problems related to housing and economic circumstances).

Social Determinants of Health (2): Food Insecurity

You also now have two codes to address health determinants based on lack of, or lack of access to, food: Z59.41 (Food insecurity) (defined as occurring when “food intake of household members is reduced and their normal eating patterns are disrupted because the household lacks money and other resources for food,” according to the U.S. Department of Agriculture (Source: www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security.aspx)) and Z59.48 (Other specified lack of adequate food), which is accompanied by the synonyms “inadequate food” and “lack of food.”

For the Z59.4- codes, Excludes1 codes for effects of hunger (T73.0), inappropriate diet or eating habits (Z72.4), and malnutrition (E40-E46) will now become Excludes2 codes, with deprivation of food (T73.0) added to the list.

Additionally, “parent code Z59.4 gets a name change from ‘Lack of adequate food and safe drinking water’ to ‘Lack of adequate food’ with the synonym ‘Inadequate drinking water supply’ deleted. But to address that issue, you’ll have a new code, Z58.6 [Inadequate drinking-water supply], which is accompanied by the synonym ‘Lack of safe drinking water,’” Moore notes.

Coding alert: “The Z59 code changes are going to be important moving forward, as they directly relate to the moderate level of medical decision making [MDM] for the office/outpatient evaluation and management [E/M] codes 99202-99215 [Office or other outpatient visit for the evaluation and management of a new/established patient …],” observes Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana. That’s because “one of the examples of moderate risk in the risk of complications and/or morbidity or mortality element of MDM for those codes is SDoH significantly limiting a patient’s diagnosis or treatment,” Holle adds.

Personal History

The CDC have also introduced two more new codes by expanding Z91.5 (Personal history of self-harm) with fourth character codes for documenting Z91.51 (Personal history of suicidal behavior) and Z91.52 (Personal history of nonsuicidal self-harm). Synonyms previously under Z91.5 — personal history of parasuicide (a suicidal attempt where the goal is not death, or an unsuccessful suicide), personal history of self-poisoning, and personal history of suicide attempt — now appear under Z91.51, while personal history of nonsuicidal self-injury, personal history of self-inflicted injury without suicidal intent, and personal history of self-mutilation appear as synonyms for Z91.52.

Immunization Counseling

Last, one new code that will probably get an immediate workout in primary care is Z71.85 (Encounter for immunization safety counseling). The ICD-10 code will pair with 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered) when your provider vaccinates any of your younger patients and educates them or their caregivers on the safety of the vaccine(s) they are administering. But it will also pair with any other immunization administration service codes, including the numerous new COVID-19 vaccine administration codes, when your provider offers education regarding the safety of a particular vaccine. It may also be appropriate in some situations where vaccine counseling occurs, but no vaccine is administered, such as 99401-99404 (Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure) …).

The code comes with Code also instructions to code an encounter for immunization (Z23) or immunization not carried out (Z28.-) as applicable, along with an Excludes1 note that you should use the encounter for health counseling related to travel (Z71.84) code instead if your provider’s immunization safety counseling is travel-related.