January 28, 2021
Social Determinants of Health Diagnosis Code Billing for 2021

Applicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care, Mercy Care DD and Mercy Care Advantage
As you are aware, beginning with dates of service on and after April 1, 2018, AHCCCS began to monitor all claims for the presence of Social Determinant ICD-10 codes. As appropriate within their scope of practice, providers should be routinely screening for, and documenting, the presence of Social Determinants. Information about any Social Determinants should be included in the member’s chart. Any Social Determinant ICD-10 diagnosis codes that are identified should be included on the submitted claims for Mercy Care members, in order to comply with state and federal coding requirements. We strongly encourage the use of these ICD-10 codes, to give a complete picture of the member, as a whole, and their needs. This includes not only behavioral health providers, but physical health providers as well.

Mercy Care appreciates the fact that our providers are billing Social Determinants of Health diagnosis codes as we requested back in 2018. However, we wanted to let you know that the Social Determinants of Health diagnosis codes should never be billed as the primary diagnosis code. These codes are always secondary. Mercy Care will deny claims where a Social Determinant of Health ICD-10 code is billed as a primary diagnosis code until a corrected claim is re-submitted.

For a list of ICD-10 codes relevant to Social Determinants of Health, please see our current 2021 Social Determinants of Health ICD-10 Diagnosis Codes. The list of Social Determinants of Health codes may be added to or updated on a quarterly basis. Providers should remain current in their use of these codes.

For more information regarding Social Determinants of Health, please reference the AHCCCS Fee For Service Manual, Chapter 4, General Billing Rules, on page 15, under Social Determinants.

These same billing rules apply to Mercy Care Advantage as well. 

As always, don't hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website.

Thank you for your attention to this important billing reminder!