It’s time for the major release of ICD-10-CM that occurs on October 1 every year. For 2023, this update reflects 1,468 new codes, 251 deleted codes, 35 revised codes, and 36 codes converted to parent.
Like the last few updates, Social Determinants of Health (SDOH) are front and center.
SDOH are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. The U.S. Department of Health and Human Services groups these into five domains: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context.1
From a coding perspective, SDOH may increase the level for the element Risk of Complications and/or Morbidity or Mortality of Patient Management. According to the 2021 revisions to the office/outpatient evaluation and management guidelines, SDOH are included as a moderate risk level of medical decision-making (MDM), but only when it’s clear that SDOH have a significantly limiting impact on the treatment.
In ICD-10-CM, SDOH-related codes are in the Z55-Z65 range:
- Z55 – Problem related to education and literacy
- Z56 – Problems related to employment and unemployment
- Z57 – Occupational exposure to risk factors
- Z58 – Problems related to physical environment
- Z59 – Problems related to housing and economic circumstances
- Z60 – Problems related to social environment
- Z62 – Problems related to upbringing
- Z63 – Other problems related to primary support group, including family circumstances
- Z64 – Problems related to certain psychosocial circumstances
- Z65 – Problems related to other psychosocial circumstances
In 2023, code set Z59.8- (Other problems related to housing and economic circumstances) is expanded to capture ways in which a patient’s health is affected by their social circumstances in much greater detail. This expansion allows providers to be more specific when coding for other problems related to housing and economic circumstances. The addition of a fifth digit allows you to document transportation insecurity, financial insecurity, and material hardship.
The three new codes and their inclusion terms are:
- Z59.82 (Transportation insecurity) – Includes excessive transportation time along with inaccessible, inadequate, lack of, unaffordable, unreliable, and unsafe transportation
- Z59.86 (Financial insecurity) – Includes bankruptcy, burdensome debt, economic strain, financial strain, money problems, running out of money, unable to make ends meet
- Z59.87 (Material hardship) – Includes material deprivation and inability to obtain adequate childcare, adequate clothing, adequate utilities, and basic needs
Language was added to the ICD-10 guideline instructing that as many SDOH codes as are necessary to describe all of the problems or risk factors should be assigned. However, they should only be assigned when the documentation specifies that the patient has an associated problem or risk factor. The example given is that ICD Z60.2 (Problems related to living alone) would not be applied to every individual that lives alone.
An ICD can be added for SDOH based on clinical staff documentation.
ICD-10 2023 also expands the patient noncompliance codes. You’ll now be able to report various reasons for a patient’s inability or unwillingness to follow medical treatment with the following new codes:
- Z91.110 (Patient’s noncompliance with dietary regimen due to financial hardship)
- Z91.118 (Patient’s noncompliance with dietary regimen for other reason)
- Z91.119 (Patient’s noncompliance with dietary regimen due to unspecified reason)
- Z91.190 (Patient’s noncompliance with other medical treatment and regimen due to financial hardship)
- Z91.198 (Patient’s noncompliance with other medical treatment and regimen for other reason)
- Z91.199 (Patient’s noncompliance with other medical treatment and regimen due to unspecified reason)
In addition, another new category of codes allows for the assignment of caregiver noncompliance and reasons for such compliance. Under this new category, Z91.A- (Caregiver’s noncompliance with patient’s medical treatment and regimen), codes are similar to the patient noncompliance codes above:
- Z91.A10 (Caregiver’s noncompliance with patient’s dietary regimen due to financial hardship)
- Z91.A20 (Caregiver’s intentional underdosing of patient’s medication regimen due to financial hardship)
- Z91.A28 (Caregiver’s intentional underdosing of medication regimen for other reason)
- Z91.A3 (Caregiver’s unintentional underdosing of patient’s medication regimen)
- Z91.A4 (Caregiver’s other noncompliance with patient’s medication regimen)
- Z91. A9 (Caregiver’s noncompliance with patient’s other medical treatment and regimen)
Wording was added to the underdosing guidelines. The new wording states that “documentation of a change in the patient’s condition is not required in order to assign an underdosing code. Documentation that the patient is taking less of a medication than is prescribed or discontinued the prescribed medication is sufficient for code assignment.”2 Therefore, the medical record simply needs to show the patient is not taking the prescribed dose of a medication, not that underdosing is adversely affecting the patient’s condition. Code T36-T50 for the underdosing, along with the appropriate noncompliance (Z91.12-, Z91.13-, and Z91.14-) or complication of care (Y63.6- Y63.9) code(s) per the updated guideline.
Other ICD updates apply to head injuries (eg, concussions).
Code set S06.0X (Concussion) was expanded with new code S06.0XA- (Concussion with loss of consciousness status unknown). The seventh digit will then identify the encounter, similar to other injuries.
- S06.0XAA (Concussion with loss of consciousness status unknown, initial encounter)
- S06.0XAD (Concussion with loss of consciousness status unknown, subsequent encounter)
- S06.0XAS (Concussion with loss of consciousness status unknown, sequela)
Previously, there was no option if loss of consciousness was unknown.
In 2023 there will be new additions to the current code sets for substance use by adding a fifth digit:
- F10.90 (Alcohol use, unspecified, uncomplicated)
- F10.91 (Alcohol use, unspecified, in remission)
- F11.91 (Opioid use, unspecified, in remission)
- F12.91 (Cannabis use, unspecified, in remission)
- F13.91 (Sedative, hypnotic, or anxiolytic use, unspecified, in remission)
- F14.91 (Cocaine use, unspecified, in remission)
- F15.91 (Other stimulant use, unspecified, in remission)
- F16.91 (Hallucinogen use, unspecified, in remission)
- F18.91 (Inhalant use, unspecified, in remission)
- F19.91 (Other psychoactive substance use, unspecified, in remission)
Finally, code set T43.6- (Poisoning by, adverse effect of and underdosing of psychostimulants) will have a new section solely for methamphetamine use. The new codes you’ll have for this condition in ICD-10 2023 are:
- T43.65 (Poisoning by, adverse effect of and underdosing of methamphetamines)
- T43.651 (Poisoning by methamphetamines accidental (unintentional))
- T43.651A (Poisoning by methamphetamines accidental (unintentional), initial encounter)
- T43.652 (Poisoning by methamphetamines intentional self-harm)
- T43.652A (Poisoning by methamphetamines intentional self-harm, initial encounter)
- T43.653 (Poisoning by methamphetamines, assault)
- T43.653A (Poisoning by methamphetamines, assault, initial encounter)
- T43.654 (Poisoning by methamphetamines, undetermined)
- T43.654A (Poisoning by methamphetamines, undetermined, initial encounter)
- T43.655 (Adverse effect of methamphetamines)
- T43.655A (Adverse effect of methamphetamines, initial encounter)
- T43.656 (Underdosing of methamphetamines)
- T43.656A (Underdosing of methamphetamines, initial encounter)
All of these changes are effective as of October 1, 2022.
References
- U.S. Department of Health and Human Services. Social Determinants of Health. Available at: https://health.gov/healthypeople/priority-areas/social-determinants-health. Accessed September 8, 2022.
- Centers for Medicare and Medicaid Services. ICD-19-CM Official Guidelines for Coding and Reporting FY 2023. Available at: ICD-10-CM Official Guidelines for Coding and Reporting FY 2023. Accessed September 8, 2022.
