Wiki Social Determinants Dx Moderate Risk

[janelbarring]

Can a social determinant Z code diagnosis count as the 2nd dx in the # of dx category even though it is under the Risk category? For example:
Pt dx is F33.1, Z62.890
Pt is responding well to meds, no change in med regime.
Pt cont. to be in conflict with parents, parents do not support her being on meds. Pt lives with parents.

Is this scenario
1 chronic illness - stable w meds = 99213
or
2 chronic illnesses - w meds = 99214
or
1 chronic illness w exacerbation due to parent conflict w meds =99214
Thanks in advance for feedback!

 

[thomas7331]

Social determinants are not diseases or medical conditions that are being treated - they are outside factors that may influence a disease. I don't believe it's the intention of the MDM tools to capture these as illnesses in and of themselves, and I would not treat them as an illness for purposes of medical decision making. In your example, the provider is not treating the parent-child conflict - they are treating the depression. Since the patient is 'responding well', I would not consider it exacerbated.