Primary Care Coding Alert

Also: check out the new guidance for reporting COPD.

Last month, we covered the office/outpatient time changes you can expect in 2024, but can you recall the new ICD-10 codes that took effect Apr. 1, 2023? How about the ones that took effect Oct. 1, 2023?

In case you need a refresher, here are a bunch of the ICD-10 updates from this past year for your quick reference.

Review the Updates to Chapters 19 and 20

Chapter 19: In April 2023, ICD-10 Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88) added several new codes, two of which allow you to report whether a patient is the target of confirmed or suspected psychological abuse in the form of threatened harm, physical violence, or sexual abuse:

• T74.3- (Psychological abuse, confirmed)
• T76.3- (Psychological abuse, suspected)

Other Chapter 19 additions allow for more granular reporting of confirmed or suspected financial abuse:

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

Remember the 7^th character: Like most of the Chapter 19 code categories, you’ll assign 7th characters A for the initial provider encounter involving the condition, D for a 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.

Chapter 20: As part of the same round of updates, ICD-10 also added a handful of important codes to Chapter 20: External Causes of Morbidity (V00-Y99). These allow you to report details about the perpetrator of abuse with greater specificity. “For example, each of the existing codes in Y07.0- [Spouse or partner, perpetrator of maltreatment and neglect] was divided into two codes, one with a sixth character of ‘0’ to indicate the perpetrator is ‘current’ and one with a sixth character of ‘1’ to indicate the perpetrator is ‘former’,” notes Kent Moore, Senior Manager, Payment Strategies, at the American Academy of Family Physicians. “Further, Y07.05- was added to capture a current (Y07.050) or former (Y07.051) non-binary partner who is a perpetrator of maltreatment and neglect,” adds Moore.

Other changes in Chapter 20 have you using an expanded code set for Y07.4- (Other family member, perpetrator of maltreatment and neglect):

• Y07.44 (Child, perpetrator of maltreatment and neglect)
• Y07.45 (Grandchild…)
• Y07.46 (Grandparent…)
• Y07.47 (Parental sibling…)
• Y07.54 (Acquaintance or friend…)

Remember: ICD-10 now defines “child” as being any of the following: adopted, biological, daughter, son, foster, in-law, non-binary, or stepchild.

Recall the New SDoH Codes

With the increasing emphasis on social determinants of health (SDoH), it’s not surprising that ICD-10 added new SDoH codes as part of their April and October 2023 updates.

Here are the 2023 additions from ICD-10 Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99).

These codes have to do with literacy, physical environment, or housing:

• Z55.6 (Problems related to health literacy)
• Z58.8- (Other problems related to physical environment)
• Z58.81 (Basic services unavailable in physical environment)
• Z58.89 (Other problems related to physical environment)
• Z59.10 (Inadequate housing, unspecified)
• Z59.11 (Inadequate housing environmental temperature)
• Z59.12 (Inadequate housing utilities)
• Z59.19 (Other inadequate housing)

These codes have to do with either custody or conflict within a household:

• 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)

These codes relate to abuse:

• Z62.814 (Personal history of child financial abuse)
• Z62.815 (Personal history of intimate partner abuse in childhood)
• Z91.413 (Personal history of adult financial abuse)
• Z91.414 (Personal history of adult intimate partner abuse)

Notice these New Noncompliance Codes

Noncompliance codes, while not technically part of the SDoH code set, can sometimes relate to SDoH. As you can see, many of the following codes allow you to report noncompliance that is a direct result of an SDoH issue:

• 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)
• 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)

Familiarize Yourself With These New Family History Codes

This year saw a few more family history codes, also. Remember that these are particularly helpful when supporting medical necessity for screening procedures.

• 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)

Remember to Always Look at the Updated Notes

In addition to expanding the number of codes in Z62.8- family, ICD-10 added a ‘Code also’ instruction applicable to all the codes under Z62.8-. 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)

Here’s another example: In previous years, J43- (Emphysema) featured an Excludes1 note, which included J44.- (Other chronic obstructive pulmonary disease). The Excludes1 note listed the conditions as emphysema with chronic (obstructive) bronchitis and emphysematous (obstructive) bronchitis, indicating that the primary code condition and the listed conditions under the note may never be coded together.

In the 2024 ICD-10-CM code set, this note has been changed to an Excludes2 note, which means you can report both conditions if the physician documents the conditions are occurring together. This is very likely, as most people with COPD have both emphysema and chronic bronchitis.