Coding Spotlight: An Anthem HealthKeepers Plus provider 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 physicians.

 

 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?

 

• Using the CMS Screening Tool, which can be found at:
• https://innovation.cms.gov/Files/worksheets/ahcm-screeningtool.pdf

 

• Submitting ICD-10-CM codes from Chapter 21 (Z00 to Z99) to identify issues that may impact member health via claims

 

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

 

SDOH diagnosis code reference

 

Z55 problems related to education and literacy:

• Z55.0 — Illiteracy and low-level literacy
• Z55.1 — Schooling unavailable and unattainable
• Z55.2 — Failed school examinations
• Z55.3 — Underachievement in school
• Z55.4 — Educational maladjustment and discord with teachers and classmates
• Z55.8 — Other problems related to education and literacy
• Z55.9 — Problems related to education and literacy, unspecified

 

Problems related to employment and unemployment:

• Z56.0 — Unemployment, unspecified
• Z56.1 — Change of job
• Z56.2 — Threat of job loss
• Z56.3 — Stressful work schedule
• Z56.4 — Discord with boss and workmates
• Z56.5 — Uncongenial work
• Z56.6 — Other physical and mental strain related to work
• 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
• Z56.9 — Unspecified problems related to employment

 

Occupational exposure to risk factors:

• Z57.0 — Occupational exposure to noise
• Z57.1 — Occupational exposure to radiation
• Z57.2 — Occupational exposure to dust
• Z57.3 — Occupational exposure to other air contaminants:
• Z57.31 — Occupational exposure to environmental tobacco smoke
• Z57.39 — Occupational exposure to other air contaminants
• Z57.4 — Occupational exposure to toxic agents in agriculture
• Z57.5 — Occupational exposure to toxic agents in other industries
• Z57.6 — Occupational exposure to extreme temperature
• Z57.7 — Occupational exposure to vibration
• Z57.8 — Occupational exposure to other risk factors
• Z57.9 — Occupational exposure to unspecified risk factor

 

Problems related to housing and economic circumstances:

• Z59.0 — Homelessness
• Z59.1 — Inadequate housing
• Z59.2 — Discord with neighbors, lodgers and landlord
• Z59.3 — Problems related to living in residential institution
• Z59.4 — Lack of adequate food and safe drinking water
• Z59.5 — Extreme poverty
• Z59.6 — Low income
• Z59.7 — Insufficient social insurance and welfare support
• Z59.8 — Other problems related to housing and economic circumstances
• Z59.9 — Problem related to housing and economic circumstances, unspecific

 

 Problems related to social environment:

• Z60.0 — Problems of adjustment to life-cycle transitions
• Z60.2 — Problems related to living alone
• Z60.3 — Acculturation difficulty
• Z60.4 — Social exclusion and rejection
• Z60.5 — Target of (perceived) adverse discrimination and persecution
• Z60.8 — Other problems related to social environment
• Z60.9 — Problem related to social environment, unspecified

 

Problems related to upbringing:

• Z62.0 — Inadequate parental supervision and control
• Z62.1 — Parental overprotection
• Z62.2 — Upbringing away from parents:
• Z62.21 — Child in welfare custody
• Z62.22 — Institutional upbringing
• Z62.29 — Other upbringing away from parents
• Z62.3 — Hostility towards and scapegoating of child
• Z62.6 — Inappropriate (excessive) parental pressure
• Z62.8 — Other specified problems related to upbringing:
• Z62.81 — Personal history of abuse in childhood:
• Z62.810 — Personal history of physical and sexual abuse in childhood
• Z62.811 — Personal history of psychological abuse in childhood
• Z62.812 — Personal history of neglect in childhood
• Z62.813 — Personal history of forced labor or sexual exploitation in childhood
• Z62.819 — Personal history of unspecified abuse in childhood
• Parent-child conflict:
• Z62.820 — Parent-biological child conflict
• Z62.821 — Parent-adopted child conflict
• Z62.822 — Parent-foster child conflict
• Other specified problems related to upbringing:
• Z62.890 — Parent-child estrangement NEC
• Z62.891 — Sibling rivalry
• Z62.898 — Other specified problems related to upbringing
• Z62.9 — Problem related to upbringing, unspecified

 

Other problems related to primary support group, including family circumstances:

• Z63.0 — Problems in relationship with spouse or partner
• Z63.1 — Problems in relationship with in-laws
• Z63.3 — Absence of family member:
• Z63.31 — Due to military deployment
• Z63.32 — Other absence of family member
• Z63.4 — Disappearance and death of family member
• Z63.5 — Disruption of family by separation and divorce
• Z63.6 — Dependent relative needing care at home
• Z63.7 — Other stressful life events affecting family and household:
• Z63.71 — Stress on family due to return of family member from military deployment
• Z63.72 — Alcoholism and drug addiction in family
• Z63.79 — Other stressful life events affecting family and household
• Z63.8 — Other specified problems related to primary support group
• Z63.9 — Problem related to primary support group, unspecified

 

Problems related to certain psychosocial circumstances:

• Z64.0 — Problems related to unwanted pregnancy
• Z64.1 — Problems related to multiparity
• Z64.4 — Discord with counselors

Problems related to other psychosocial circumstances:

• Z65.0 — Conviction in civil and criminal proceedings without imprisonment
• Z65.1 — Imprisonment and other incarceration
• Z65.2 — Problems related to release from prison
• Z65.3 — Problems related to other legal circumstances
• Z65.4 — Victim of crime and terrorism
• Z65.5 — Exposure to disaster, war and other hostilities
• Z65.8 — Other specified problems related to psychosocial circumstances
• Z65.9 — Problem related to unspecified psychosocial circumstances.

 

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.

 

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