The April 2023 ICD-10-CM update adds many new codes for reporting external causes of injuries as well as expanded codes for reporting factors influencing health status more succinctly. But read the revised guideline for reporting social determinants of health (SDOH) before using these codes.
Changes to the Tabular List
In the ICD-10-CM Tabular List of Diseases and Injuries, there are new codes and other changes in Chapters 19 and 20, effective April 1, 2023.
Chapter 19 – Injury, poisoning and certain other consequences of external causes (S00-T88)
Under T74.3 Psychological abuse, confirmed, and T76.3 Psychological abuse, suspected, the ICD-10-CM update adds these inclusion terms:
- Target of threatened harm, confirmed
- Target of threatened physical violence, confirmed
- Target of threatened sexual abuse, confirmed
New codes for reporting financial abuse are also being added:
T74.A Financial abuse, confirmed
T74.A1 Adult financial abuse, confirmed
T74.A2 Child financial abuse, confirmed
T76.A Financial abuse, suspected
T76.A1 Adjust financial abuse, suspected
T76.A2 Child financial abuse, suspected
These codes require an appropriate 7th character, as applicable to indicate initial encounter (A), subsequent encounter (D), or sequela (S) such as T74.A1XA (the X is a placeholder).
Chapter 20 – External Causes of Morbidity (V00-Y99)
The codes in this chapter are informational only, should never be sequenced first, and are generally not even required. However, providers are encouraged to report these codes, as applicable, for use in research and evaluation of injury prevention strategies. Per ICD-10-CM guidelines, “The first-listed external cause code should correspond to the cause of the most serious diagnosis due to an assault, accident, or self-harm ….” The guidelines specify the order of hierarchy when there are multiple external cause codes; abuse takes priority over all other external causes.
Under Y07 Perpetrator of assault, maltreatment and neglect, an Includes note is being added April 1 to specify “perpetrator of verbal abuse,” and several codes are being converted to parent codes (Y07.01-Y07.04) and one new parent code is being added (Y07.05). Under these codes, 10 new child codes are being added that specify the gender identity of the perpetrator (husband, wife, male, female, non-binary) and the status of the relationship to the patient (i.e., currently or formerly intimate or dating).
Under Y07.4 Other family member, perpetrator of maltreatment and neglect, codes Y07.44-Y07.47 are being added in the ICD-10-CM update to identify the perpetrator as a child, grandchild, grandparent, or parental sibling, respectively. Each code has a long list of inclusion terms. Per the ICD-10-CM guidelines, “Adult and child abuse, neglect and maltreatment are classified as assault. Any of the assault codes may be used to indicate the external cause of any injury resulting from the confirmed abuse. … When the perpetrator is known, a code from Y07, Perpetrator of maltreatment and neglect, should accompany any other assault codes.”
Under Y07.5 Non-family member, perpetrator of maltreatment and neglect, there is one new code (Y07.54) to identify the perpetrator as an acquaintance or friend.
Chapter 21 – Factors influencing health status and contact with health services (Z00-Z99)
More codes for social determinants of health (SDOH) are being added in the ICD-10-CM update to report factors that may prevent a patient from obtaining care or following through with recommended treatment.
Under Z55 Problems related to education and literacy, new code Z55.6 Problems related to health literacy is being added. This code includes three inclusion terms.
Under Z58 Problems related to physical environment, new parent code Z58.8 other problems related to physical environment and child codes Z58.81 Basic services unavailable in physical environment, and Z58.89 other problems related to physical environment are being added.
Under Z59 Problems related to housing and economic circumstances, Z59.1 Inadequate housing is being converted to a parent code and four new child codes (Z59.10-Z59.12 and Z59.19) are being added to provide more detail about why the housing is inadequate such as no heat or water. A new Excludes2 note instructs you to use Z59.8- for other problems related to housing and economic circumstances, so the line of questioning on intake forms or by providers will need to be very precise to accurately code housing insecurities.
Under Z59.8, an Excludes2 note is added to indicate the appropriate codes for extreme poverty, financial insecurity, low income, and material hardship. And under Z59.82 Transportation insecurity, an Excludes2 note is added to direct you to Z75.3 for unavailability and inaccessibility of healthcare facilities.
Also in the April update to ICD-10-CM, existing code Z59.87 is being revised to specify the material hardship is due to limited financial resources, not elsewhere classified.
Under Z62.81 Personal history of abuse in childhood, there are two new codes for reporting history of child financial abuse (Z62.814) and history of intimate partner abuse in childhood (Z62.815).
Under Z91.1 Patient’s noncompliance with medical treatment and regimen, there is new Code also and Excludes2 notes. Also, Z91.14, Z91.15, Z91.41 are converted to parent codes and six new child codes are being added to identify the cause of the noncompliance or other risk factors.
ICD-10-CM Guideline Changes
In the 2023 ICD-10-CM Official Guidelines for Coding and Reporting, Chapter 20, section 17 Social Determinants of Health now reads:
Social determinants of health (SDOH) codes describing social problems, conditions, or risk factors that influence a patient’s health should be assigned when this information is documented in the patient’s medical record. Assign as many SDOH codes as are necessary to describe all of the social problems, conditions, or risk factors documented during the current episode of care. For example, a patient who lives alone may suffer an acute injury temporarily impacting their ability to perform routine activities of daily living.
When documented as such, this would support assignment of code Z60.2, Problems related to living alone. However, merely living alone, without documentation of a risk or unmet need for assistance at home, would not support assignment of code Z60.2. Documentation by a clinician (or patient-reported information that is signed off by a clinician) that the patient expressed concerns with access and availability of food would support assignment of code Z59.41, Food insecurity. Similarly, medical record documentation indicating the patient is homeless would support assignment of a code from subcategory Z59.0-, Homelessness.
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