Primary Care Coding Alert

Plus: See how financial difficulty is incorporated into several new codes.

Starting April 1, 2023, 42 new ICD-10-CM codes go into effect. Changes were light this time around, but as family practice coders, you’re sure to find many of these codes useful to help you round out patient records.

Read on for a look at these new codes from the ICD-10 chapters that cover financial abuse, maltreatment and neglect, and social determinants of health (SDoH).

Know the New Chapter 19 Codes

ICD-10 Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88) will see 12 new codes that relate to confirmed or suspected financial abuse. What’s particularly helpful about these new codes is they allow you to specify whether the subject of the abuse is an adult or child, and distinguish between initial and subsequent visits, as well as sequela.

The new codes are as follows:

• T74.A (Financial abuse, confirmed)
  • T74.A1 (Adult financial abuse, confirmed)
  • T74.A2 (Child financial abuse, confirmed)
• T76.3 (Financial abuse, suspected)
  • T76.A1 (Adult financial abuse, suspected)
  • T76.A2 (Child financial abuse, suspected)

Initial, Subsequent, Sequela: Like most of the Chapter 19 code categories, you’ll assign 7th characters A for the initial provider encounter involving the condition, D for the subsequent encounter, and S for an encounter involving the condition’s sequela. You’ll also need to use an X place marker in 6th character position to give the full code.

Other helpful additions involve inclusion terms for T74.3 (Psychological abuse, confirmed) and T76.3 (Psychological abuse, suspected) that will give you a way to accurately document patients who are the target of confirmed or suspected harm, physical violence, or sexual abuse.

Know the New Chapter 20 Codes

ICD-10 Chapter 20: External Causes of Morbidity (V00-Y99) will see 15 new codes that relate to maltreatment and neglect. Now, you’ll be able to code the perpetrator with greater specificity, using an expanded code set for Y07.0- (Spouse or partner, perpetrator of maltreatment and neglect).

This means the codes you’re currently using to indicate the perpetrator of abuse will soon be the unbillable parent codes. For example, Y07.01 (Husband, perpetrator of maltreatment and neglect) will be broken down into Y07.010 (Husband, current…) and Y07.011 (Husband, former…). ICD-10 has structured the other codes the same way, allowing you to specify the perpetrator of abuse as being the current or former wife, male partner, female partner, or non-binary partner.

The addition of four other codes will allow you to identify maltreatment coming from other family members:

• Y07.44 (Child, perpetrator of maltreatment and neglect)
• Y07.45 (Grandchild…)
• Y07.46 (Grandparent…)
• Y07.47 (Parental sibling…)

Each of these four codes will also list relationship details as inclusion terms, making it easy for you assign the correct code. For example, under Y07.44, you’ll find that ICD-10 defines “child” as being any of the following: adopted, biological, daughter, son, foster, in-law, non-binary, or stepchild. Lastly, you’ll also be able to document whether the maltreatment or neglect originates with a friend or acquaintance of the patient with the addition of Y07.54 (Acquaintance or friend…).

Know the New Chapter 21 Codes

The remaining 15 new codes are related to SDoH and can be found in ICD-10 Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99). These new codes address patient problems related to education and literacy (Z55-), physical environment (Z58-), housing and economic circumstance (Z59-), personal history of abuse in childhood (Z62.81-), and patient noncompliance (Z91.1-).

“Potential risk adjustment based on SDoH means related new and revised ICD-10-CM codes could have an impact beyond just capturing patient data in the medical record,” notes Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. Because of this, it’s therefore increasingly important to pay attention to these details when coding.

Z55-: You’ll find Z55.6 (Problems related to health literacy) added to the code set, which will apply to situations when the patient has difficulty understanding their health information or instructions or has problems completing the forms, per the new code’s inclusion terms.

Z58-: ICD-10 is adding three new codes related to problems concerning the physical environment. Those include parent code Z58.8 (Other problems related to physical environment) and billable code Z58.81 (Basic services unavailable in physical environment), which refers to lack of internet, telephone, or utilities due to them being geographically unavailable or an otherwise inadequate environment. Code Z58.89 (Other problems related to physical environment) is also going to be available for you to use.

Z59-: Four new codes cover inadequate housing, which will greatly help you report more specific debilitating economic circumstances. Until these recent changes, lack of heat, restriction of space, technical defects and unsatisfactory surroundings all fell under Z59.1 (Inadequate housing). ICD-10 deleted those inclusion terms for that code and has added the following codes:

• Z59.10 (Inadequate housing, unspecified)
• Z59.11 (Inadequate housing environmental temperature)
• Z59.12 (Inadequate housing utilities)
• Z59.19 (Other inadequate housing)

The ICD-10 update now includes synonyms under Z59.12 to denote lack of electricity, gas, oil, and water services as well as pest infestation, restriction of space, technical defects, and unsatisfactory surroundings for Z59.19.

Coding alert: It may seem like Z58.81 and Z59.12 describe the same thing, but they don’t. Z58.81 denotes basic services that are simply unavailable to the patient, either due to an inadequate physical environment or geographic location. For instance, a patient may not be able to obtain internet service due to the remote location in which the patient lives. In comparison, Z59.12 implies a lack of economic resources (e.g., the patient cannot afford to pay for electricity). These two codes can be coded together, per the Excludes2 note under Z59.12 that ICD-10 included with the updates.

Also, you’ll find a change to Z59.87 (Material hardship). The change in the code’s descriptor to (Material hardship due to limited financial resources, not elsewhere classified) and revisions to its inclusion terms tell you to use the code specifically when the patient is unable to obtain such material necessities as childcare, clothing, utilities, and other basic needs.

Z62.8-: You’ll find two new codes under the parent code Z62.81 (Personal history of abuse in childhood). One is Z62.814 (Personal history of child financial abuse), and the other is Z62.815 (Personal history of intimate partner abuse in childhood). These codes come with Excludes notes to which you’ll need to pay attention. An Excludes1 note under code Z62.814 tells you it’s mutually exclusive to T74.A2, and the Excludes 2 note under Z62.815 shows it may be coded with any of the T74.- codes when both are applicable.

Z91.1-: The last handful of ICD-10 additions concern patient noncompliance. While there is no change to Z91.1 (Patient’s noncompliance with medical treatment and regimen), you’ll find a new Code also note, directing you to identify the underdosing of a specific drug, if applicable. The following codes are new, however:

• Z91.141 (Patient’s other noncompliance with medication regimen due to financial hardship)
• Z91.148 (… for other reason)
• Z91.151 (Patient’s noncompliance with renal dialysis due to financial hardship)
• Z91.158 (… for other reason)

You’ll also have new codes to add specificity in the personal history of psychological trauma, not elsewhere classified (Z91.4) category: Z91.413 (Personal history of adult financial abuse) and Z91.414 (Personal history of adult intimate partner abuse).

Expert tip: Coders need to be on the lookout for SDoH language in the documentation, not only to remember to submit those codes, but also for any supporting documentation to justify them. For example, “Codes that state ‘problems,’ such as Z60.2 (Problems related to living alone) need to have supporting documentation to indicate a risk or concern by the practitioner, per the 2023 ICD-10 Guideline I.C.21.c.17.” explains 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. In other words, you would not submit Z60.2 simply because the patient lives alone. While Z60.2 is not one of the new codes this time around, it’s always wise to submit as much relevant information as is available.