The annual ICD-10-CM classification system update for FY2023 brings many new codes and included in this we find three new codes for the Social Determinants of Health or SDOH category. Attention for capturing SDOH continues across all healthcare settings. Ensuring that clinical documentation and coding are in sync is a priority. 

It is well known that socioeconomic factors impact ones health and health outcomes. In fact, the Department of Health and Human Services (HHS) provides this definition: 

“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.” 

Of course, we need data on these SDOHs in order to improve upon those conditions that impact one’s health and well-being. The ICD-10-CM coding classification system has provided a group of codes to capture this important information and data. Coding and Clinical Documentation Integrity professionals need to be aware of clinical documentation and understand the SDOH descriptions in order to capture this data. In fact, in the Official Guidelines for Chapter 21 Social Determinants of Health, the following is stated: 

Codes describing problems or risk factors related to social determinants of health (SDOH) should be assigned when this information is documented. Assign as many SDOH codes as are necessary to describe all of the problems or risk factors. These codes should be assigned only when the documentation specifies that the patient has an associated problem or risk factor. For example, not every individual living alone would be assigned code Z60.2, Problems related to living alone. Note the underlined text indicates new language for FY2023. 

ICD-10-CM Chapter 21 Factors influencing health status and contact with health services (Z00-Z99) has three new codes added to category Z55-Z65 (Persons with potential health hazards related to socioeconomic and psychosocial circumstances) for FY2023, and it’s important to read over the inclusion terms under each code, as listed below: 

Z59.8 Other problems related to housing and economic circumstances 

NEW Z59.82 (transportation insecurity): 

• Excessive transportation time 
• Inaccessible transportation 
• Inadequate transportation 
• Lack of transportation 
• Unaffordable transportation 
• Unreliable transportation and Unsafe transportation  

NEW Z59.86 Financial insecurity: 

• Bankruptcy 
• Burdensome debt 
• Economic strain 
• Financial strain 
• Money problems 
• Running out of money 
• Unable to make ends meet 
• Excludes2: extreme poverty (Z59.5) 
  •  Low income (Z59.6) 
  •  Material hardship, not elsewhere classified (Z59.87) 

NEW Z59.87 Material hardship 

• Material deprivation 
• Unable to obtain adequate childcare 
• Unable to obtain adequate clothing 
• Unable to obtain adequate utilities
• Unable to obtain basic needs
• Excludes2: extreme poverty (Z59.5
  • Financial insecurity, not elsewhere classified (Z59.86)
  • Low income (Z59.6) 

Yes, we continue across healthcare to see and hear a greater emphasis of SDOH, not only here in the United States but in many other countries as well, which is a good thing. Let’s do our part by querying appropriately for SDOH and capturing the coded data no matter the setting as this will add to the full patient story. I encourage all readers of this blog to obtain the AHIMA white paper on SDOH as this provides a wealth of great information regarding the capture and use of these important data elements. In addition, review the detailed inclusion terms for SDOH for FY2023. 

References:

• Official Guidelines for Coding and Reporting FY2023
• Social Determinants of Health – Healthy People 2030 | health.gov
• https://journal.ahima.org/page/social-determinants-of-health-improving-capture-and-use-by-applying-data-governance-strategies 

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