New ICD-10 codes take effect Oct. 1: What they say about social determinants of health

September 30, 2021
In addition to the new codes for social determinants of patients' health, a new, billable diagnosis code was created to report encounters for immunizations.
Updated,expanded ICD-10-CM codes for social determinants of health take effect Oct. 1

In a nod to the social conditions that can impact a patient’s health, a number of updated ICD-10 codes further reflect patient experiences and can be reported to insurers.

Effective Friday, Oct. 1, these new Z category codes can be reported to describe several situations including:

  • Z55 Problems related to education and literacy (existing category).
    • Z55.5 Less than a high school diploma (new code).
  • Z58 Problems related to physical environment (existing category).
    • Z58.6 Inadequate drinking-water supply (new code).
  • Z59 Problems related to housing and economic circumstances (existing category).
    • Z59.01 Sheltered homelessness (new code).

A new, billable diagnosis code—Z23—was created to report encounters for immunizations. Read how doctors of optometry and eligible optometry students were added to categories of qualified health care providers authorized to prescribe, dispense and administer FDA-approved COVID-19 vaccines.

“For the last few years, the medical community, health insurance providers and social justice advocates have been pushing for recognition of and impact from the Social Determinants of Health (SDOH),” says Rebecca Wartman, O.D., AOA Coding and Reimbursement Committee member and the AOA advisor to the American Medical Association CPT Editorial Panel. “These include lack of food or secure food sources; lack of secure, steady or any housing; lack of transportation; unsafe environments, such as abuse, threats of violence. These (SDOH) have had a major role in some reforms across the board. 

“Providers have been strongly encouraged to use screening forms and methods to determine if and when their patients are impacted by SDOH which, in turn, impact health outcomes,” Dr. Wartman adds. “Thus, ICD-10-CM finally updated some of its codes to be used to indicate when a patient is impacted by these SDOH.”

AOA member resources for coding

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