CMS report is based on 2016-2017 data.
It’s been two years since the American Hospital Association (AHA) shouted from the rooftops that documentation by any interprofessional team would be accepted as validation to use the ICD-10-CM Z codes, as opposed to only documentation by physicians.
In the social determinants of health (SDoH) age, these Z codes are viewed as a logical way for healthcare organizations to recoup the massive costs incurred for treatment and hospitalization of admissions related to non-clinical psychosocial and socioeconomic needs. However, if the healthcare industry has learned one thing over the years, it is never to cloud an issue with logic.
The release of the January 2020 Centers for Medicare & Medicaid Services (CMS) Office of Minority Health Issue Brief reveals the glaring reality of how infrequently those ICD-10-CM Z codes are being used. In the issue brief, Z Codes Utilization among Medicare Fee-for-Service (FFS) Beneficiaries in 2017, a snapshot is provided:
There is one important fact to bear in mind about the results. The data is from 2016-2017. While not long ago, this was just as organizations were becoming aware of the dramatic financial implications of the SDoH, and potential value of the codes. However, it was still prior to the heavy industry emphasis for organizations to use the codes.
Even though CMS missed a prime opportunity to provide organizations a fiscal hand by approving Z59.0, homelessness, as a co-morbidity for the 2020 Inpatient Prospective Payment System (IPPS), the codes are of undeniable value to healthcare organizations. They speak to population health needs by providing valuable case mix complexity data to organizations, plus countless other fiscal imperatives (e.g., grants, cross-sector collaboration, mergers, and acquisitions).
Appropriate use of the ICD-10-CM Z codes will not only impact future reimbursement but all current advocacy efforts underway by entities to increase the codes available for use. Expanded utilization will also continue to force CMS’s hand in approving the codes’ reimbursement.
Our Monitor Mondays listeners’ survey hit to the core of this issue, asking:
What are the most utilized ICD-10-CM Z Codes for the Medicare FFS beneficiaries at your organization? Do the responses surprise you?
Programming Note: Listen to Ellen Fink-Samnick’s live reporting on the State of the Social Determinants weekly on Monitor Mondays, 10-10:30 a.m. EST.
Increasing pressure to improve emergency department (ED) throughput has led many hospitals to adopt workflows in which ED physicians initiate inpatient or outpatient observation orders
Hospitals across the country are facing mounting financial pressure from Medicare Advantage (MA) plans. One increasingly common tactic used by MA payers is systematic downcoding:
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