Monday, December 27, 2021

Social Determinants of Health

What do “empty nest syndrome”, “victim of torture”, and “homelessness” have in common?  They are codable conditions that fall under the umbrella phrase “social determinants of health”.

There has been a huge focus in healthcare on social determinants of health (SDOH) in recent years. This installment of “In the kNOW” will explain what SDOH means and how coding professionals are impacted by this focus.

Let’s start by defining social determinants of health by looking at the Healthy People 2030 initiative of the Health and Human Services Department under the Office of Disease Prevention and Health Promotion.  Their definition of SDOH is:

“Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

 They go on to breakdown the SDOH into five domains as follows:

·        Economic stability

·        Health Care Access and Quality

·        Education Access and Quality

·        Neighborhood and Built Environment

·        Social and Community Context

Source: Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved [09/10/2021], from

Social determinants of health can identify inequity and disparity when it comes to health.  For example, if a patient has lack of adequate food and safe drinking water, these can contribute to poor health.  So might the fact that the patient is homeless or at risk for becoming homeless.

This is where coding professionals can make an impact.  What better way to capture this data than through the use of diagnostic codes, in this case Z codes.  In a guideline change for the 2022 ICD-10-CM code updates at I.C.21.17 Social Determinants of Health, coders are directed to assign these codes when the information is documented.  The SDOH codes are no longer optional.

Additional information under this guideline states that the assignment of SDOH codes may come from documentation supplied by clinicians and does not have to be solely noted by the patient’s provider.  The leeway in ascribing the diagnosis code to information from other providers is based on the premise that the information is not a medical diagnosis, but rather social information.  If the documentation from these clinicians, such as case managers, nurses, or social workers, is in the medical record, then it can be used as the basis for assigning the codes.

Coding professionals should also recall that a patient’s self-report documentation may also be used for assigning SDOH if a provider or clinician has signed off of the information and it has been incorporated into the medical record.

The Z-code categories from Z55-Z65 are for persons with potential health hazards related to socioeconomic and psychosocial circumstances.  This is their breakdown:

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


Coding professionals should review these code categories and familiarize themselves with the conditions that fall under them.  For example, in Z55, illiteracy (Z55.0) and underachievement in school (Z55.3) can be coded.  At Z56, coding professionals can capture stressful work schedules (Z56.3) or sexual harassment on the job (Z56.81).  At Z62, inadequate parental supervision (Z62.0) or conversely, parental overprotection (Z62.1) can be coded. 

Take a few minutes to review the book and refresh your memory on these categories and codes.  This will help as you comb through documentation reminding you what to watch for when looking for SDOH problems.  

Now you are In the kNOW!!


About the Author 

Dianna Foley, RHIA, CHPS, CCS, CDIP  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.