Everything You Need to Know About the ICD-10-CM April 2023 Update

The new updates to the ICD-10-CM code system include 42 additions and one revision. The Centers for Disease Control and Prevention (CDC) along with National Center for Health Statistics (NCHS) is implementing these codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) effective from April 1st, 2023.

The purpose of this update is to enable the collection of health-related social needs (HRSNs) in a better way. Additionally there is one update in the guidelines I.C.21.c.17. Social Determinants of Health.

Take a look at the below table for the overview of the update.

New codes in Chapter 19:

12 new codes are added in Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88)

These new codes specify whether the financial abuse concerns an adult or child and also highlight whether it’s an initial or subsequent encounter or a sequela.

Child and adult financial abuse:

Financial abuse occurs when a perpetrator limits the access to financial assets in order to control the victim. Without financial resources, the victim of the abuse has limited options for separating from the perpetrator. This includes any of various methods used to withhold money, steal money or control assets that rightly belong to the victim.

Below are two new categories added for the Child and adult financial abuse for confirmed and suspected cases.

Confirmed: T74.A- Financial abuse, confirmed

                               T74.A1- Adult financial abuse, confirmed

                               T74.A2 Child financial abuse, confirmed

Suspected: T76.A- Financial abuse, suspected

                               T76.A1- Adult financial abuse, suspected

                               T76.A2- Child financial abuse, suspected

New codes in Chapter 20:

In the below table, you can find the 15 new codes and their description added to Chapter 20: External Causes of Morbidity (V00-Y99)

These new codes specify the perpetrator as one of the following: husband, wife, male partner, female partner (The new codes specify if the perpetrator is a current or former spouse or partner) non-binary partner child, grandchild, grandparent, parental sibling, or acquaintance or friend.

New codes in Chapter 21:

15 new codes are added in Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99). 

Social determinants of health (SDOH) codes describe the social problems, conditions, or risk factors that influence a patient’s health.

Problems related to education and literacy Z55

Z55.6 Problems related to health literacy

           Difficulty understanding health related information

           Difficulty understanding medication instruction

           Problem completing medical forms

Problems related to physical environment Z58

Z58.8 Other problems related to physical environment

              Z58.81 Basic services unavailable in physical environment

            Unable to obtain internet service, due to unavailability in geographic area

            Unable to obtain telephone service, due to unavailability in geographic area

            Unable to obtain utilities, due to inadequate physical environment 

               Z58.89 Other problems related to physical environment

Problems related to housing and economic circumstances Z59

Below are the new expansions from this category

               Z59.1 Inadequate housing

                           Z59.10 Inadequate housing, unspecified

                                   Inadequate housing NOS

                           Z59.11  Inadequate housing environmental temperature

                                   Lack of air conditioning

                                   Lack of heating

                           Z59.12 Inadequate housing utilities

                                   Lack of electricity services

                                   Lack of gas services

                                   Lack of oil services

                                   Lack of oil services

                                          Excludes 2: Basic services unavailable in physical environment (Z58.81)

                                                        Lack of adequate food (Z59.4-)

                                                        Other problems related to housing and economic circumstances (Z59.8-)

                      Z59.19 Other inadequate housing

                                   Pest infestation

                                   Restriction of space

                                   Technical defects in home preventing adequate care

                                   Unsatisfactory surroundings

Code revision

Code description is revised for the code Z59.87 from “Material hardship” to “Material hardship 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 clothing due to limited financial resources 

                      Unable to obtain basic needs due to limited financial resources

Problems related to upbringing Z62 new expansions

                           Z62.814 Personal history of child financial abuse

                                              Excludes1: current child financial abuse (T74.A2)

                           Z62.815  Personal history of intimate partner abuse in childhood 

                                      Excludes2: adult and child abuse, neglect and other maltreatment, confirmed (T74.-)

Non compliance with medication regimen 

New codes under subcategory Z91.14 to identify the patient's non compliance with medication regimen due to either financial hardship or another reason.

Similar additions under subcategory Z91.15 to identify the patient's non compliance with renal dialysis due to either financial hardship or another reason.

Two new codes added under subcategory Z91.4 Personal history of psychological trauma, not elsewhere classified to describe a personal history of adult adult financial abuse (Z91.413) and personal history of adult intimate partner abuse (Z91.414)

I.C.21.c.17. Social Determinants of Health

Below guideline change related to SDOH and clarifies that the SODH codes describe social problems, conditions and risk factors. These codes should be assigned when information is documented in the medical record. 

Code Z06.2 Living alone is assigned when the patient has a risk or unmet need for assistance at home due to living alone, not that they merely live alone.

Patient reported information that is signed off by a clinician can be used to support code assignment.

Table of drugs and chemicals

There are 7 minor fixes for the code T43.65- as revised the 6th character from 2 (self-harm) to 3 (assault) for the all entries related to drug Metamfetamine for below entries in table of drugs and chemicals.

Desoxyephedrine, Metamfetamine, Methamphetamine, Methedrine, Methyl-amphetamine, Methylamphetamine and Speed.

References:

CMS: https://www.cms.gov/files/zip/icd-10-ms-drgs-v401-effective-april-1-2023.zip