November 21, 2019
Social Determinants of Health Diagnosis Code Billing

Ap plicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care, Mercy Care DD and Mercy Care Advantage
Mercy Care appreciates the fact that our providers are billing Social Determinants of Health diagnosis codes as we requested 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 has been allowing these claims to process as billed, however, effective January 1, 2020, these claims, if not billed appropriately, will be denied until a corrected claim is resubmitted. 

Below please find reference to the AHCCCS Fee For Service Manual, Chapter 4, General Billing Rules , on page 15, under Social Determinants , it states:   

Beginning with dates of service on and after April 1st, 2018, AHCCCS will begin 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 the social determinant 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 AHCCCS members, in order to comply with state and federal coding requirements.
Note: Social determinants are not the primary ICD-10 code. They are secondary ICD-10 codes.

This same billing rule applies to Mercy Care Advantage as well. 

To review the list of AHCCCS Social Determinants of Health ICD-10 Codes , please click on the link. 

As always, don't hesitate to contact your Mercy Care Provider Relations 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 billing issue!