Over the past year we have seen and read more and more about the reporting of Social Determinants of Health or “SDOH”. Clearly there has been a COVID-19 impact to the overall interest in these social economic and psychosocial aspects of an individual. More research and studying of our healthcare social equity and inequality is on the top of all healthcare discussions. Understanding the complete patient story and the other influences is vital to providing care, directing patients and family to resources, it’s vital to accessing of care,  improving care, and overall patient outcomes.  

The American Health Information Management Association (AHIMA) has voiced support for a request by the Gravity Project to expand the ICD-10-CM codes for SDOH.

NOTE:  The Social Interventions Research and Evaluation Network (SIREN) launched the Gravity Project, a national collaborative to improve and harmonize documentation around social determinants of health (SDOH) data in EHR systems. The Gravity Project seeks to identify coded data elements and associated value sets to represent social determinants of health data documented in EHRs across four clinical activities: screening, diagnosis, planning, and interventions. Visit: Gravity Project | HL7 International

A recent AHIMA Journal article contains information regarding this SDOH proposal and the recommended implementation date of October 1, 2021 rather than 2022. You can access this Journal article at: CMS and CDC/NCHS Discuss Possible Biannual ICD-10-CM/PCS Code Implementation Dates | Journal Of AHIMA

Another AHIMA Journal article devoted to SDOH is available at: Improving ICD-10-CM Coding for Social Determinants of Health | Journal Of AHIMA and this is a great read and resource to have.

As a reminder, the SDOH ICD-10-CM codes are in Chapter 21: Factors influencing health status and contact with health services (Z00-Z99) and are located in the subcategory range of Z55 – Z65, Persons with potential health hazards related to socioeconomic and psychosocial circumstances. Here is the subcategories and titles (complete code assignment requires all characters to be utilized):

  • Z55  Problems related to education and literacy
  • Z56  Problems related to employment and unemployment
  • Z57  Occupational exposure to risk factors
  • Z58  Problems related to physical environment
  • Z59  Problems related to housing and economic circumstances
  • Z60  Problems related to social environment
  • Z62  Problems related to upbringing
  • Z63  Other problems related to primary support group, including family circumstances
  • Z64  Problems related to certain psychosocial circumstances
  • Z65  Problems related to other psychosocial circumstances

An example of the SDOH code level detail is the following within Z56:

Z56.8 Other problems related to employment

Z56.81 Sexual harassment on the job

Z56.82 Military deployment status

Z56.89 Other problems related to employment

Coding guidance from the AHA Coding Clinic fourth quarter 2019 tells us that we may assign the SDOH codes based upon health record documentation from clinicians, community health workers, social workers, and case managers.

As Health Information Management (HIM) professionals we can help improve SDOH capture, by taking action, first hold a discussion regarding the SDOH documentation and codes with a multidisciplinary team, including physicians, discharge planning, and social workers. Second submit comments to the CDC/NCHS by May 7th, 2021 regarding the SDOH code proposal. To send comments to the CDC/NCHS at nchsicd10cm@cdc.gov. Next discuss SDOH within your coding staff and use this to develop  a written policy regarding the documentation and coding needed for SDOH data capture.  Now circle back with your SDOH multidisciplinary group and identify documentation improvement areas, even within the HER and provide the appropriate education. Another step to take is to request or develop a specific data report on the SDOH codes, looking back over the past two years and determine the frequency of these codes being reported each year. Then continue to run SDOH reports each quarter going forward and check to see what the frequency rates are (hopefully they increase over time). When coding audits are conducted be sure that the auditors are looking for SDOH reporting and accuracy also, discuss this prior to the audit being performed. And finally spread the word about the importance of documenting and coding SDOH, be an advocate, support the capture of these valuable and important data elements!

Written by Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA Approved ICD-10-CM/PCS Trainer

Reimbursement Management Consultants (RMC) can provide assistance with medical coding support, auditing, education, compliance consulting, and HCC/risk adjustment services. RMC is a woman-owned, US-based and operated company which specializes in a variety of medical coding and auditing services. Contact us here.