ATLANTA—Updated and expanded ICD-10 codes that take into account the Social Determinants of Health (SDOH) are set to take effect today, as well as a new, billable diagnosis code that was created to report encounters for immunizations. The updated codes consider the social conditions that can impact a patient’s health and reflect patient experiences that can be reported to insurers. The new Z category codes, effective Oct. 1, 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. A number of states have authorized optometrists and eligible optometry students to prescribe, dispense and administer FDA-approved COVID-19 vaccines, along with qualified health care providers, as reported in VMAIL.
“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),” Rebecca Wartman, OD, AOA Coding and Reimbursement Committee member and the AOA advisor to the American Medical Association CPT Editorial Panel, told AOA News. “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 added. “Thus, ICD-10-CM finally updated some of its codes to be used to indicate when a patient is impacted by these SDOH.”

ICD-10 codes were developed by the World Health Organization (WHO). ICD-10-CM codes were developed and are maintained by CDC's National Center for Health Statistics under authorization by the WHO.