Radiology Coding Alert

2022 ICD-10-CM Z code revisions focus on food insecurity, housing insecurity, and more.

When you flip to Chapter 21: Factors Influencing Health Status and Contact with Health Services of the ICD-10-CM manual, you’ll find many new diagnosis codes that will help you document the Social Determinants of Health (SDOH) — the social circumstances that can affect a patient’s health — in exceptional detail when they go into effect on Oct. 1, 2021.

Regularly documenting the SDOH of your practice’s patients could prove to be beneficial when the physician is designing a care plan. Check out next year’s ICD-10-CM Z code changes and learn how they might benefit your radiology practice.

Select From These Converted Codes to Document Housing Insecurity

The Centers for Disease Control and Prevention (CDC) has added several new codes to the existing Z59.- (Problems related to housing and economic circumstances) codes to continue to facilitate documentation of SDOH.

Code Z59.0 (Homelessness) has been converted to a parent and now requires a 5th character for greater specificity. The three codes you’ll use to document homelessness include:

• 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 6th characters to Z59.81- (Housing instability, housed),” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

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 a home loan, is past due on rent or mortgage, and/or has undergone multiple unwanted moves in the last 12 months. The CDC has 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).

Acquire an Understanding of Food Insecurity Codes

The CDC has added two new codes to the Z59.4- (Lack of adequate food) code set, which address the health determinants based on lack of, or lack of access to, food. You’ll use Z59.41 (Food insecurity) when you come across documentation that indicates lowered food intake or eating schedules that are interrupted. According to the U.S. Department of Agriculture, food insecurity occurs 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” (URL: www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security.aspx).

Additionally, Z59.48 (Other specified lack of adequate food) is accompanied by synonyms such as “inadequate food” and “lack of food,” so you should be on the lookout for that verbiage in the physician’s notes.

“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.

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

Understand How SDOH Can Affect a Radiologist’s Care Plan

Scenario: A patient is referred to a radiologist for a routine screening mammogram (77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed). During the examination, the physician finds an abnormality and schedules a diagnostic mammogram (77065-77066 Diagnostic mammography, …) the following week.

The radiologist’s office calls to confirm the appointment the next week, and the patient asks to cancel the appointment. When asked if they’d like to reschedule, the patient replies they can’t take the time off work and can’t afford the cost of transportation to the appointment that is far from their house.

If the provider had documented the patient’s financial hardship with a code such as Z59.9 (Problem related to housing and economic circumstances, unspecified) during the initial visit, they may have to refer the patient to another practice with flexible hours closer to the patient’s home to better accommodate the situation. “The care plan may be affected by the Social Determinant of Health, which could increase the overall complexity of patient management,” says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania.

Remember: The SDOH factor must directly impact the plan of the provider who is caring for the patient. In this scenario, the physician’s or radiologist’s office may have found a different radiologist that would be near the patient’s home with operating hours that fit in the patient’s schedule. When care providers document SDOH, then they can draft a care plan that takes the SDOH into account, so the patient can receive the care they need that suits their situation. As a new element in Medical Decision Making (MDM) for office/outpatient evaluation and management (E/M) visits, SDOH corresponds to a moderate risk with respect to patient management.

Stay Up to Date on the New Z-Code Guidelines

The CDC has also updated and revised the guidelines on how to document SDOH findings. You’ll find the following guidelines under Section I.C.21.c.17 of the ICD-10-CM Official Guidelines for Coding and Reporting, “Codes describing social determinants of health (SDOH) should be assigned when this information is documented.”

If the patient experiencing potentially hazardous health conditions that relate to their socioeconomic or psychological circumstances, you may assign codes based on the medical record documentation from clinicians who are not the patient’s provider, as this information constitutes social information.

This indicates you may use “documentation of social information from social workers, community health workers, case managers, or nurses, if their documentation is included in the official medical record,” according to the guideline. You’re also allowed to assign codes to self-reported SDOH if a provider or clinician approves the information and incorporates it into the medical record.