Social Determinants of Health (SDOH) Refresher: What You Need to Know

a healthcare professional in a hospital setting using a pen and clipboard reviewing social determinants of health icd-10 information

Social Determinants of Health (known as SDOH) were first defined by the World Health Organization (WHO) as: the conditions in which people are born, grow, live, work and age. ICD-10-CM Z codes provide a standardized data set and means to capture patient social situations which better align with identifying patient needs.

Social Determinants of Health (SDOH) are now at a significant level of importance within many aspects and settings of healthcare. The World Health Organization (WHO) states that: These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries.

The healthcare industry is a buzz about these medical codes and how important they are to population health, research, outcomes, funding of social programs, etc. Using these specific ICD-10-CM Z codes and standardizing the assignment and use of Z codes is extremely important. Social needs of individuals or patients can be identified, enabling us to connect them with the appropriate resources and services they require. Population health trends can be easily identified through the clinical data, and the social determinants of health ICD-10-CM Z codes can help this also. ICD-10-CM Z codes provide a standardized data set and means to capture patient social situations which better align with identifying patient needs.

ICD-10-CM Code Range Z55-65 Persons with Potential health hazards related to socioeconomic and psychosocial circumstances, is found in Chapter 21. Persons with potential health hazards related to socioeconomic and psychosocial circumstances, or SDOH code assignment may be based on medical record documentation from clinicians involved in the care of the patient who are not the patient’s provider since this information represents social information, rather than medical diagnoses. For example, medical coding professionals may utilize documentation of social information from social workers, community health workers, case managers, or nurses, if their documentation is included in the official medical record/encounter.

For FY 2024 we had some new SDOH codes released as well as tabular additions. The following is the listing from the ICD-10-CM tabular:

NEW Z62.23 Child in custody of non-parental relative

Child in care of non-parental family member

Child in custody of grandparent

Child in kinship care

Guardianship by non-parental relative

Code also, if applicable, child in welfare custody (Z62.21)

NEW Z62.24 Child in custody of non-relative guardian

Code also, if applicable, child in welfare custody (Z62.21)

Z62.8 Other specified problems related to upbringing

Code also, if applicable:

Add absence of family member (Z63.3-)

Add disappearance and death of family member (Z63.4)

Add disruption of family by separation and divorce (Z63.5)

Add other specified problems related to primary support group (Z63.8)

Add other stressful life events affecting family and household (Z63.7-)

Z62.82 Parent-child conflict

NEW Z62.823 Parent-step child conflict

NEW Z62.83 Non-parental relative or guardian-child conflict

NEW Z62.831 Non-parental relative-child conflict

Grandparent-child conflict

Kinship-care child conflict

Non-parental relative legal guardian-child conflict

Other relative-child conflict

Excludes1: group home staff-child conflict (Z62.833)

NEW Z62.832 Non-relative guardian-child conflict

Excludes1: group home staff-child conflict (Z62.833)

NEW Z62.833 Group home staff-child conflict

Z62.89 Other specified problems related to upbringing

NEW Z62.892 Runaway [from current living environment]

Child leaving living situation without permission

Within the Inpatient Prospective Payment System FY2024 rule, the Centers for Medicare and Medicaid “finalized a change to the severity designation of the three ICD-10-CM diagnosis codes describing homelessness (e.g., unspecified, sheltered, and unsheltered) from non-complication or comorbidity (NonCC) to complication or comorbidity (CC), based on the higher average resource costs of cases with these diagnosis codes compared to similar cases without these codes. This action is also consistent with the Administration’s goal of advancing health equity for all, including members of historically underserved and under-resourced communities, as described in the President’s January 20, 2021, Executive Order 13985 on “Advancing Racial Equity and Support for Underserved Communities Through the Federal Government.” As SDOH diagnosis codes are increasingly added to billed claims, CMS plans to continue to analyze the effects of SDOH on severity of illness, complexity of services, and consumption of resources.”

These ICD-10-CM codes are related to “homelessness:

            ICD-10-CM Z59.00 Homelessness unspecified (CC)

            ICD-10-CM Z59.01 Sheltered homelessness     (CC)

            ICD-10-CM Z59.02 Unsheltered homelessness (CC)

Educating providers is vital for both inpatient and outpatient settings regarding SDOH and the need for initial patient screening to capture the determinants within the documentation of the encounter. Remember that SDOH is social information not clinical, so the capture of these codes can be based upon documentation other than the physician provider, meaning nonphysician providers. The ICD-10-CM Official Guidelines for Coding and Reporting has dedicated guidance for the coding of SDOH. Medical Coding and Clinical Documentation Integrity (CDI) professionals should review the guidelines, the FY2024 changes and prepare appropriate query forms to assist in capturing SDOH documentation and codes.

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