State & FederalMedicaidJune 1, 2020

Coding spotlight: Provider’s guide to code social determinants of health

What are social determinants of health (SDOH)?
The World Health Organization (WHO) defines SDOH as "conditions in which people are born grow, work and age. 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 inequalities." Capturing SDOH is becoming a necessary element of documentation.

Official coding guidelines for SDOH - new update
For 2019, the ICD-10-CM Official Guidelines for Coding and Reporting has been updated to allow reporting SDOH using the documentation of clinicians other than the patient's provider. Most of the patient-specific SDOH information is captured by ancillary staff supporting the physcians.

Do SDOH affect everyone?
The SDOH codes are very powerful tools in capturing the complexity of patient populations and allowing application of more accurate care. These conditions affect patient care. This publicly reported data will also improve capture of conditions that impact readmission reduction and mortality metrics.

SDOH diagnosis codes are one of the few tools that are shared collectively to measure and evaluate SDOH on a national scale. How can providers address SDOH issues for the members?

Coding SDOH

SDOH codes are represented in ICD-10-CM code categories Z55 to Z65 — persons with potential health hazards related to socioeconomic and psychosocial circumstances. Codes in the Z55 to Z65 groupings include the following:

Code grouping

Examples

Z55 — Problems related to education and literacy

Illiteracy/low level of literacy, schooling unavailable

Z56 — Problems related to employment and unemployment

Unemployment, change of job, threat of job loss, military deployment status, sexual harassment on the job

Z57 — Occupational exposure to risk factors

Occupational exposure to noise, radiation, dust, tobacco, toxic agents in agriculture, extreme temperature

Z59 — Problems related to housing and economic circumstances

Homelessness, inadequate housing, discord with neighbors, extreme poverty, low income

Z60 — Problems related to social environment

Adjustment to lifestyle transition, problems living alone, acculturation difficulty, social exclusion and rejection

Z62 — Problems related to upbringing

Inadequate parental supervisions and control, parental overprotection, institutional upbringing

Z63 — Other problems related to primary support group, including family circumstances

Problems with spousal or other relationship, absence of a family member, alcoholism or drug addiction in family

Z64 — Problems related to certain psychosocial circumstances

Problems with unwanted pregnancy, problems related to multiparity, discord with counselors

Z65 — Problems related to other psychosocial circumstances

Conviction, imprisonment, victim of crime or terrorism


Open the attachment to view the SDOH diagnosis code reference.


Resources

World Health Organization, About social determinants of health, found online at: https://www.who.int/social_determinants/sdh_definition/en.

 

ICD-10-CM Expert for Physicians, the complete official code set, Optum360, LLC. 2020.

ATTACHMENTS: SDOH diagnosis code reference.pdf (pdf - 0.06mb), Coding 2020-06-01.png (png - 0.02mb)

PUBLICATIONS: June 2020 Anthem Blue Cross Provider News - California