There is a growing interest and need for knowing and capturing the social determinants of health or SDOH. We are experiencing more and more interest in social aspects that impact or influence one’s health, i.e., homelessness. More organizations are getting involved in the attention and promotion of collecting SDOH documentation and ICD-10-CM Z codes.

As we all know, there is strong evidence of healthcare disparity across our nation and while attending the recent American Medical Association (AMA) 2023 CPT Symposium there was a presentation by the Centers for Medicare and Medicaid Services (CMS) on the Social Determinants of Health ICD-10-CM codes. These particular ICD-10-CM codes can greatly help with tracking and trending these disparities.

The Centers for Medicare and Medicaid Services continues to bring greater awareness, support and guidance to the collection of ICD-10-CM Z codes for Social Determinants of Health. CMS reports that in 2016 the FFS claims with Z codes were reported to be 946,000 and in 2019 the figure rose to 1.263 million. This is great to see, but more should be and can be done, across all payers and all settings.

SDOH ICD-10-CM code Z59.0 problems related to housing and economic circumstances is the most reported SDOH code within the FFS claims data. There is some good information on the National Alliance to End Homelessness website regarding homelessness. (The Alliance is a nonpartisan, nonprofit organization committed to preventing and ending homelessness in the United States) According to the NAEH, in January 2020, there were 580,466 people experiencing homelessness on our streets and in shelters in America. Most were individuals (70 percent), and the rest were people in families with children. They lived in every state and territory, and they include people from every gender, racial, and ethnic group.

Another group that is working to raise awareness and also address homelessness is the National Health care Homelessness Council. The Council is a membership organization uniting thousands of health care professionals, people who lived the experience of homelessness, and advocates in homeless health care. The NHCHC cites several reasons for using Z59.0 to document homeless patients:

• The ability to compare data across provider organizations
• The opportunity to signal patient’s high-risk acuity to various providers when patients and their medical records move within and across systems
• The ability to document the medical complexity of a system’s patient population compared with that of other providers
• A way to track medical outcomes of a system’s homeless patients
• A reduced chance that providers will be financially penalized under value-based payment methods for serving high-needs populations

*Note the website link is listed in the references at the end of this blog.

The Official Guideline for Coding and Reporting I.B.14, Documentation by Clinicians, tells us the following: 

Other than the Patient’s Provider, has been updated so the coding professional may use clinical documentation by others to code the social determinants of health, which fall in the category range of Z55 – Z65 (Persons with potential health hazards related to socioeconomic and psychosocial circumstances).

Although SDOH codes have been found to be underreported but growing, it is vital for Health Information Management (HIM) professionals to promote standardized documentation and tracking of social determinants of health (SDOH) elements. Capturing these data elements is critical to ensuring the attainment of the highest level of health possible for all people across the United States. Initiate a coding policy that addresses the coding of SDOH and promotes consistency.

Discuss with your Clinical Documentation Integrity the documentation and possible querying for SDOH and share the value of this medical record information with providers and others in the healthcare team. In addition, discuss the role that the electronic health record (EHR) can play in capturing SDOH information and data. We can do more, we can do it together!

References:

• https://www.who.int/teams/social-determinants-of-health#:~:text=The%20social%20determinants%20of%20health%20%28SDH%29%20are%20the,and%20systems%20shaping%20the%20conditions%20of%20daily%20life
• Social Determinants of Health | CDC
• https://endhomelessness.org/
• https://nhchc.org/
• https://acdis.org/articles/news-sdoh-codes-are-underutilized-according-icd-10-cm-study