Practice Management Alert

The 2022 revisions have a strong focus on SDoH.

Many of the 191 new ICD-10 codes that go into effect Oct. 1, 2021, can be found in Chapter 21: Factors influencing health status and contact with health services.

Many of these codes will help you add crucial details about a patient’s life to their medical record, because many of these codes involve social determinants of health (SDoH).

Note Housing Insecurity With These Codes

In their continuing efforts to facilitate documentation of SDoH, the Centers for Disease Control and Prevention (CDC) has 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 three codes:

• 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.”

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

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

Acknowledge Food Insecurity With These Code Updates

You also now have two codes to address health determinants based on lack of, or lack of access to, food: Z59.41 (Food insecurity) (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)) and Z59.48 (Other specified lack of adequate food), which is accompanied by the synonyms “inadequate food” and “lack of food.”

For the Z59.4- codes, Excludes1 codes for effects of hunger (T73.0), inappropriate diet or eating habits (Z72.4), and malnutrition (E40-E46) will now become Excludes2 codes, with deprivation of food (T73.0) added to the 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,’” Moore notes.