New ICD-10 codes take effect Oct. 1: What they say about social determinants of health
In a nod to the social conditions that can impact a patient’s health, a number of updated ICD-10 codes further reflect patient experiences and can be reported to insurers.
Effective Friday, Oct. 1, these new Z category codes can be reported to describe several situations including:
- Z55 Problems related to education and literacy (existing category).
- Z55.5 Less than a high school diploma (new code).
- Z58 Problems related to physical environment (existing category).
- Z58.6 Inadequate drinking-water supply (new code).
- Z59 Problems related to housing and economic circumstances (existing category).
- Z59.01 Sheltered homelessness (new code).
A new, billable diagnosis code—Z23—was created to report encounters for immunizations. Read how doctors of optometry and eligible optometry students were added to categories of qualified health care providers authorized to prescribe, dispense and administer FDA-approved COVID-19 vaccines.
“For the last few years, the medical community, health insurance providers and social justice advocates have been pushing for recognition of and impact from the Social Determinants of Health (SDOH),” says Rebecca Wartman, O.D., AOA Coding and Reimbursement Committee member and the AOA advisor to the American Medical Association CPT Editorial Panel. “These include lack of food or secure food sources; lack of secure, steady or any housing; lack of transportation; unsafe environments, such as abuse, threats of violence. These (SDOH) have had a major role in some reforms across the board.
“Providers have been strongly encouraged to use screening forms and methods to determine if and when their patients are impacted by SDOH which, in turn, impact health outcomes,” Dr. Wartman adds. “Thus, ICD-10-CM finally updated some of its codes to be used to indicate when a patient is impacted by these SDOH.”
AOA member resources for coding
- AOA Marketplace offers the latest 2022 Codes for Optometry manual and quick reference, AOA Common ICD-10 Coding card for doctors’ coding reference.
- Ask the AOA’s coding experts your specific questions.
- AOA Coding Today is an online, comprehensive database that contains information in real time for CPT, ICD-10 and HCPCS coding and research. The website is tailored specifically to optometry, assists doctors and staff in correct reimbursement and compliance, and has an easy-to-use code diagnosis ability based on region.
Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2023, the AOA continues to press for Congress to act on reforms that would give doctors of optometry an annual, permanent inflationary Medicare payment tied to the Medicare Economic Index.
The federal government and private payers are heavily scrutinizing the use of modifier -25. When used appropriately, it can help to ensure that patients receive appropriate treatment and that doctors of optometry are reimbursed appropriately for their service. If you believe a claim that includes modifier -25 was inappropriately denied, follow appropriate criteria when appealing.