May Coding Tip Corner

Risk Adjustment Changes
Big changes to Risk Adjustment are underway for calendar year 2024. Stay tuned for more next month on the transition from Version 24 (2020 model) to Version 28 (2024 model). We will also be providing more information on these changes in our Provider Roundtable sessions. We would love it if you and your office could attend these meetings. 

Social Determinants of Health
How does your office handle updating the Social Determinations of Health (SDOH) section of your patients’ records?

This goes hand in hand with the Gold Standard of Documentation. Specifically, let’s say your patient has had a decline with their financial situation and there is no notation of that on their SDOH. Then a different provider orders a new medication or an increase in dosage. The patient may be unable to cover the added expense, and subsequently may not start the change in medication! For most of your patients, chances are this area of the record does not change often, so just make it a standard procedure to ask when patients come into the office for a visit.

Revised Diagnosis Code effective 4/1/2023 regarding SDOH
The short, long, and full descriptions have changed.

CMS has revised the code for material hardship to include “due to limited financial resources, not elsewhere classified.” 

Z59.87 Material hardship due to limited financial resources, not elsewhere classified:

• Material deprivation due to limited financial resources.
• Unable to obtain adequate childcare due to limited financial resources.
• Unable to obtain adequate clothing due to limited financial resources.
• Unable to obtain adequate utilities due to limited financial resources.
• Unable to obtain basic needs due to limited financial resources.

This excludes the following: 

• Extreme poverty (Z59.5)
• Financial insecurity, not elsewhere classified (Z59.86)
• Low income (Z59.6)
• Problems related to upbringing (Z62.-)

Chapter 21 from the ICD-10-CM Coding Guidelines: Factors influencing health status and contact with health services (Z00-Z99)
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 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 changing 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.

Social Determinants of Health. (CDC, 2023)

ICD-CM Quarterly Updates
April 2023 ICD-10-CM updates:

• ICD-10 – CM
  
  • 42 additions       
  • 7 deletions
  • 1 revision

• ICD-10 – PCS
  
  • 34 additions
  • no deletions
  • no revisions

Further Breakdown – Additions:

• Chapter 19: Regards to Injury, Poisoning, and certain other consequences of External Causes codes (S00-T88). There are 12 new codes regarding confirmation or suspected financial abuse.
• Chapter 20: External Causes of Morbidity codes (V00 – Y99). There are 15 new codes regarding maltreatment and neglect.
• Chapter 21: Factors influencing Health Status and Contact with Heath Services codes (Z00 – Z99). There are 15 new codes. These codes deal with SDOH.

Deleted Diagnosis Codes: 

• Deleted four codes regarding maltreatment or neglect perpetrated by husband, wife, or partner.
  The new codes in Chapter 20 specify if the perpetrator is a current or former spouse or partner.
• Deleted code for inadequate housing CMS expanded codes in Chapter 21 (Factors influencing Health Status and Contact with Health Services).
• Deleted two codes that apply to the patient’s noncompliance with a medication regimen or renal dialysis. New expanded codes in Chapter 21 will not only replace the noncompliance codes but will specify what makes the patient noncompliant (such as a financial hardship).
  
  

It is important to note there are new ICD-10 – PCS Codes for Procedures as well. These can be found in the following sections:

Medical and Surgical Section:

• Heart and Great Vessels: One new code
• Lower Arteries: One new code
• Upper Bones: Six new codes
• Lower Bones: Six new codes
  
  

The Administration Section:

• Circulatory: 14 new codes
• The New Technology Section: Five new codes

Documentation Reminder
If you are documenting either a CPT code or ICD-10-CM code that has a specific timeframe on it, please double check that you are within the allotted time!

• Example: An MI can only be coded as new for the first 28 days from the onset of the event. The actual date must be documented.
• There are specific timeframes referenced for CPT codes for certain testing as well. Example: 99454 only allowed once every 30 days.

Telehealth Updates
Based on current COVID-19 trends, the Department of Health and Human Services (HHS) has ended the federal Public Health Emergency (PHE) for COVID-19, declared under Section 319 of the Public Health Service (PHS) Act, to expire at the end of the day on May 11, 2023. (HHS Press Office, 2023)

Major Medicare telehealth flexibilities will not be affected. The vast majority of current Medicare telehealth flexibilities that Americans — particularly those in rural areas and others who struggle to find access to care — have come to rely upon over the past two years will remain in place through December 2024 due to the bipartisan Consolidated Appropriations Act, 2023 passed by Congress in December 2022. (HHS Press Office, 2023)

References
CDC. (2023, April 1). ICD-10-CM official guidelines for coding and reporting FY 2023. Retrieved from Centers for                    Disease Control and Prevention: https://stacks.cdc.gov/view/cdc/126426

HHS Press Office. (2023, February 22). Fact Sheet: COVID-19 Public Health Emergency Transition Roadmap.                         Retrieved from U.S. Department of Health and Human Services: www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html