Social Determinants of Health: A Coding Guide

Caitlin Wham, CCS Health and Wellness Leave a Comment

Social Determinants of Health: A Coding Guide

As value-based healthcare models continue to grow, the collection and documentation of social determinants of health data has become a key factor in improving patient care and outcomes. As HIM and Coding Professionals, our role in understanding, collecting and appropriately reporting social determinants of health is more important than ever.

What are social determinants of health?

Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Positive conditions are often associated with improved outcomes and reduced cost, while negative conditions have been shown to negatively affect outcomes.

The Healthy People initiative, released by the U.S. Department of Health and Human Services, has identified five key areas of social determinants of health (SDOH). Each of these five determinant areas reflect several key issues that make up the underlying factors in the arena of SDOH.

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Education Access and Quality

  • Early childhood education and development
  • Language and literacy
  • Enrollment in higher education
  • High school graduation

Health Care and Quality

  • Access to health care
  • Access to primary care
  • Health literacy

Neighborhood and Built Environment

  • Crime and violence
  • Quality of housing
  • Access to foods that support health eating patterns
  • Environmental conditions

Social and Community Context

  • Social cohesion
  • Civic participation
  • Discrimination
  • Incarceration

Economic Stability

  • Food insecurity
  • Housing instability
  • Employment
  • Poverty

Why are social determinants of health important?

Addressing SDOH positively affects both the patient and the healthcare system by improving patient outcomes and reducing unnecessary expenditures such as hospital readmission, length of stay, and use of post-acute care. Addressing SDOH is also a primary approach to achieving health equity.

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Social determinants of health such as poverty, unequal access to health care, lack of education, stigma, and racism are underlying, contributing factors of health inequities. Data related to patient’s social needs is crucial in efforts to improve the health of patients and communities.

Social determinants of health, official guidance:

ICD-10-CM Official Guidelines for Coding and Reporting FY 2021 I.B.14 states:

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This means that any member of a patient’s care team can collect SDOH data during an encounter. This includes providers, social workers, case managers and nurses. SDOH data can be collected at intake through health risk assessments, screening tools, patient-provider interaction as well as self-reporting.

 

The role of the Coding Professional:

Coding professionals are responsible for reviewing the patient’s medical record to identify SDOH and assign the appropriate ICD-10-CM code(s). This documentation can be found throughout the medical record, including social work notes, provider documentation, nursing documentation and screening tools.

Coding professionals should be aware of and begin utilizing the ICD-10-CM codes included in categories Z55-Z65, listed below:

ICD-10

Description

Number of Sub-Codes

Z55

Problems related to education and literacy

7

Z56

Problems related to employment and unemployment

12

Z57

Occupational exposure to risk factors

12

Z59

Problems related to housing and economic circumstances

10

Z60

Problems related to social environment

7

Z62

Problems related to upbringing

24

Z63

Other problems related to primary support group, including family circumstances

14

Z64

Problems related to certain psychosocial circumstances

3

Z65

Problems related to other psychosocial circumstances

8

 

The table below was released by AHA to identify Problems/Risk Factors Included in each ICD-10-CM Code Category:

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Additional Information

Additional information regarding Social Determinants of Health can be found below.

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