By J’NON GRIFFIN
RN, MHA, HCS-D, HCS-H, HCS-C, HCS-O, COS-C
Sr. Vice President of Compliance & Coding
Behavioral health providers will be impacted by several ICD-10 coding changes that become effective Oct. 1, including some new Z codes for reporting Social Determinants of Health (SDoH).
These changes are among hundreds of additions, deletions, and revisions to the ICD-10 code set for FY2025. In all, the Centers for Medicare and Medicaid Services (CMS) has approved 252 additions, 36 deletions, and 13 revisions to the ICD-10 code set for FY2025.
Changes will be in effect for all patient encounters and/or discharges occurring between Oct. 1, 2024, and Sept. 30, 2025.
While the revisions impact many chapters of the ICD-10 coding set, behavioral health providers will want to pay particular attention to changes in two chapters:
- Chapter 5, Mental , Behavioral, and Neurodevelopmental Disorders: In this chapter, new codes have been added for reporting several eating disorders.
- Chapter 21, Factors Influencing Health Status and Contact with Health Services: In this chapter, new codes have been added to report Social Determinants of Health (SDoH), circumstances which could impact or interfere with diagnosis and treatment.
ICD-10 changes affecting behavioral health
ICD-10 continues to drill down on specifics with changes each fiscal year that more finely differentiate disorders, symptoms, and conditions. For FY2025, behavioral health providers will see several new codes in Chapter 5 to increase eating disorder specificity.
Under F50 Eating disorders, new coding options will include:
- Anorexia nervosa, restricting type (F50.010-F50.019)
- Binge eating/purging type (F50.020-F50.029)
- Bulimia nervosa (F50.20-F50.25)
- Binge eating disorder (F50.810-F50.819)
Coding changes in Chapter 5 include new codes for two other disorders as well:
- Pica in adults (F50.83)
- Rumination disorder in adults (F50.84)
New Z-codes for reporting SDoH in FY2025
Other coding changes for FY2025 which could impact behavioral health providers include new codes in Chapter 21.
In addition to new codes in this chapter for reporting some genetic susceptibilities and obesity (Z15.2), two new SDoH codes have been added:
- Insufficient health insurance coverage (Z59.71)
- Welfare support (Z59.72)
Ensure compliance with ICD-10 coding changes
Staying abreast of ICD-10 coding changes for FY2025 is important for all behavioral health providers to ensure billing and coding compliance, avoid claim denials, and keep cash flow moving.
It's also important for quality reporting purposes, and in the case of Certified Community Behavioral Health Centers (CCBHCs), meeting certification criteria. The Substance Abuse and Mental Health Services Administration (SAMHSA) requires CCBHCs to screen all clients for SDoH issues to provide clinicians with a more realistic understanding of what may be needed for treatment and services to be effective.
Required SDoH screening becomes part of the foundation for care planning and case management. It drives timelines, priorities, and care delivery. Accurate coding is an essential part of the SDoH assessment.
Read my previous article here about the 4 standardized assessment tools SAMHSA allows for compliant SDoH screening.
Behavioral health providers should make certain all coders, physicians, clinicians, and others who report ICD-10 codes and/or conduct SDoH assessments at your organization are familiar with these changes. EHR updates may also be needed.
SimiTree can help
SimiTree’s experienced behavioral health compliance experts have a comprehensive understanding of coding, quality, and billing practices designed to stand up to audit scrutiny.
Our analytics and compliance experts go the extra mile for clients, not just ensuring coding and billing compliance, but showing organizations how to build improvements into data-collecting processes, streamline workflow, implement tracking controls, and make use of standardized screening tools and assessments.
With a full complement of outsourced coding, billing, revenue management, and compliance services, SimiTree offers the solutions your organization needs to ensure the highest level of accuracy and performance day in and day out.
Reach out to us today, and let’s work together to shore up compliance and improve performance at your organization.
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J’non Griffin serves as Senior Vice President/Principal for the Compliance as well as Coding divisions at SimiTree. Her healthcare career spans three decades of clinical and leadership experience, and she has a track record of helping many provider types implement effective compliance programs. She is a certified ACHC and CHAP consultant and holds additional certifications in diagnosis coding and other healthcare specialties. As an AHIMA ambassador, she was instrumental in the implementation of ICD-10.