Pediatric Coding Alert

Food and water insecurity and housing instability codes get a 2022 expansion.

As a pediatric coder, you’ll need to pay close attention to the expansion of the Z55-Z65 (Persons with potential health hazards related to socioeconomic and psychosocial circumstances) ICD-10 code group that is due to take effect beginning on Oct. 1, 2021. Not only will the changes help you add greater specificity to your social determinants of health (SDoH) coding, but they may also possibly justify office/outpatient evaluation and management (E/M) levels in the process.

But before we outline the changes for you, here’s a quick reminder about why documenting SDoH is so important.

Why You Should Be Reporting SDoH

In Pediatric Coding Alert volume 23 issue 6, we discussed the importance of documenting SDoH, noting that they are “conditions in the environments in which 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,” according to the Office of Disease Prevention and Health Promotion (ODPHP) (Source: www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health).

We also noted that from a pediatric coding perspective, documenting SDoH is significant as “social determinants of health are one of the 5 Anticipatory Guidance priorities in every Infancy Visit and in most visits thereafter,” according to the American Academy of Pediatrics (AAP) current Bright Futures Guidelines (See brightfutures.aap.org/Bright Futures Documents/BF4_POCKETGUIDE.pdf).

Moreover, “The upcoming Z59.- (Problems related to housing and economic circumstances) codes. Code Z59.0 (Homelessness) code changes are going to be important moving forward, as they directly relate to the moderate level of medical decision making (MDM) when they significantly limit a patient’s diagnosis or treatment in the risk of complications and/or morbidity or mortality element of MDM as it relates to office/outpatient E/M codes 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …),” observes Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

Take in What’s New in Reporting Food Insecurity and Lack of Clean Water

Naturally, your patients’ health is going to be negatively affected if they experience food insecurity, which is defined as occurring 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,” according to the U.S. Department of Agriculture (Source: www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security.aspx).

That’s why ICD-10 2022 has added two new codes to help you document this: Z59.41 (Food insecurity) and Z59.48 (Other specified lack of adequate food), which is accompanied by the synonyms “inadequate food” and “lack of food.”

But just as important as the codes are the new instructions that accompany them. They tell you that effects of hunger (T73.0), inappropriate diet or eating habits (Z72.4), and malnutrition (E40-E46) can now be reported with the other Z59.4 codes as ICD-10 has changed their Excludes1 status to Excludes2. ICD-10 has also added deprivation of food (T73.0) to that list.

Additionally, “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,’” according to Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

Make a Home for These Housing Instability Codes

In this current round of revisions, ICD-10 has also added a number of new codes to the existing Z59.- (Problems related to housing and economic circumstances) codes. Code Z59.0 (Homelessness) is now broken out to two codes: 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.”

“The CDC has also 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 sixth characters to Z59.81 [Housing instability, housed],” says Moore. Here, the new code group includes Z59.811 (Housing instability, housed, with risk of homelessness), Z59.812 (Housing instability, housed, homelessness in past 12 months), and 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 home loan, past due on rent or mortgage, or unwanted multiple moves in the last 12 months. That’s because ICD-10 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).