ICD-10 and Procedure Codes Related to ACEs

So when we use a screening tool for ACEs, we can use a procedure code to capture it. That code is:

96160 Administration of patient-focused health risk assessment instrument (e.g., health hazard appraisal) with scoring and documentation, per standardized instrument

• • • Here is the screening tool for adults ACE Questionnaire for Adults.pdf
    • Here is a guide for family practitioners from MacKay & Taylor (2020)  ACEs Booklet Family Practitioners.pdf
    • Here are the screening tools for pediatric patients from ACES Aware (n.d.)
      • Child: PEARLS-Tool-Child-Parent-Caregiver.pdf
      • Teen: PEARLS-Teen-Parent-Caregiver.pdf
      • Teen, Self Reported: PEARLS-Tool-Teen-Self-Report.pdf

If you are interested in the ICD 10 coding options that may be used for ACEs in adults (and sometimes children), I did a little research and found some - there are probably more but here are a few according to ICD10Data.com (n.d.-a):

• Z00 - Z99 Factors influencing health status and contact with health services
  • Z62 Problems related to upbringing
  • Z62.81 Personal history of abuse in childhood
  • Z62. 812 Personal history of neglect in childhood
  • Z62.898 Other specified problems related to upbringing
  • Z62.9 Negative life events in childhood  
  • Z91.49 Other personal history of psychological trauma, not elsewhere classified
  • Z87.828 Personal history of other (healed) physical injury and trauma
  • Z91 Personal risk factors, not elsewhere classified

And the Z59 Child Codes section has individual diagnoses codes for SDOH! From Codify (n.d.) here they are:

• • Z59 Problems related to housing and economic circumstances
  • Z59.0 Homelessness
  • Z59.1 Inadequate housing
  • Z59.2 Discord with neighbors, lodgers and landlord
  • Z59.3 Problems related to living in residential institution
  • Z59.4 Lack of adequate food
  • Z59.5 Extreme poverty
  • Z59.6 Low income
  • Z59.7 Insufficient social insurance and welfare support
  • Z59.8 Other problems related to housing and economic circumstances
  • Z59.9 Problem related to housing and economic circumstances, unspecified

Terrific, right??

So, we can use the Z59 codes to capture issues related to pediatrics, and the codes in the previous section are probably better used for adults, if I am understanding it correctly. Finally, here are a few more interesting codes:

• • R68.13  Apparent life threatening event in infant (ALTE)
  • R68.19  Other nonspecific symptoms peculiar to infancy
  • Z62. 21 Child in welfare custody

The Diagnosis Related Groups (DRG) dataset 951 is for "Other factors influencing health status" (ICD10Data.com, n.d.-b, title). "DRGs are used for determining reimbursement and as an indicator for other types of reporting such as budgeting, physician profiling, clinical outcomes, case mix calculation and clinical research" (The University of Texas Medical Branch at Galveston, n.d., para. 13).

Additional note to remember:

Z codes in general are used as secondary codes, unless it is for an encounter (Z00.00, Z00.121, Z00.129, etc).

And here is a linked resource that is terrific: Tips for ACEs Related Coding  It summarizes coding practices, like I attempted to above. It was put together by the New Jersey Chapter of the American Academy of Pediatrics (NJAAP) (2019). 

References

ACES Aware. (2023, March 16). Screening tools. Learn About Screening. https://www.acesaware.org/learn-about-screening/screening-tools/ 

Codify. (n.d.). ICD-10-CM code for problems related to housing and economic circumstances Z59. https://www.aapc.com/codes/icd-10-codes/Z59 

ICD10Data.com. (n.d.-a). 2023 ICD-10-cm diagnosis code z62: Problems related to upbringing. https://www.icd10data.com/ICD10CM/Codes/Z00-Z99/Z55-Z65/Z62-/Z62 

ICD10Data.com. (n.d.-b). DRG 951. 2023 DRG List Page. https://www.icd10data.com/ICD10CM/DRG/951 

MacKay, L., & Taylor, M. (2020, December 16). A toolkit for practitioners. ACEs Booklet FPs v8-Electronic.pdf. https://divisionsbc.ca/sites/default/files/Divisions/Kootenay%20Boundary/ACEs%20Booklet%20v5_Electronic.pdf 

New Jersey Chapter of the American Academy of Pediatrics (NJAAP). (2019, May 20). TIPS for aces-related coding . Tips for ACEs Related Coding_noMark.pdf. https://njaap.org/wp-content/uploads/2021/10/Tips-for-Coding.pdf 

The University of Texas Medical Branch at Galveston. (n.d.). Description of coding and DRG assignment. Revenue Cycle Operations. https://www.utmb.edu/rco/Employees/DCDA