If you have been wondering why it is important to collect social determinants of health (SDoH) information, wonder no more. This month “In the kNOW” will explore this topic and share how our October FY2024 ICD-10-CM update illustrates how SDoH is going to begin impacting reimbursement.
Let’s begin by addressing what SDoH are. This definition of social determinants of health comes from 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.”
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
https://health.gov/healthypeople/objectives-and-data/social-determinants-health
The data collected from the coding of SDoH can assist governmental agencies in identifying areas of inequity and disparity when it comes to health and healthcare. For example, lack of adequate food or unsafe drinking water are contributors to poor health. Capturing this data through the assignment of diagnostic codes, in this case Z-codes in the range of Z55-Z65 (persons with potential health hazards related to socioeconomic and psychosocial circumstances), makes collecting and analyzing this information much easier than a manual data collection.
Our official coding guidelines have mandated the collection of this data when it is documented. This is no longer optional. Since this is social information rather than a medical diagnosis, SDoH can be taken from a provider, other clinicians, or the patient themselves. If the patient self-reports the SDoH information, as long as it is signed off on by the provider and incorporated into the patient’s record, it can be coded.
Now, beginning October 1, 2023, the assignment of three specific SDoH codes will have an impact on inpatient Medicare severity diagnosis-related groups (MS-DRGs). These codes all relate to homelessness.
Z59.01 Sheltered homelessness
Doubled up
Living in a shelter such as: motel, scattered site housing, temporary or transitional living situation
Z59.02 Unsheltered homelessness
Residing in place not meant for human habitation such as: abandoned buildings, cars, parks, sidewalk
Residing on the street
With the FY2024 ICD-10-CM update, these three codes will become recognized as complications or comorbidities, otherwise known as CCs. When applied to an inpatient account paid under the Medicare inpatient prospective payment system (IPPS), these codes will raise the reimbursement level for any base level MS-DRG that has options for either CCs or MCCs (major complications or comorbidities).
It stands to reason that additional SDoH codes in the Z59 category for problems related to housing and economic circumstances may be added as CCs in the future.
Now, coding professionals have three reasons for collecting SDoH data:
- It is the right thing to do, to collect the data for reporting on healthcare disparity and inequity.
- It is mandated under the official coding guidelines.
- Organizations are beginning to see increased reimbursement by the use of SDoH codes.
About the Author
Dianna Foley, RHIA, CHPS, CCS, CDIP, is an HIM professional with over 25 years of experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA, along with being an AHIMA-approved ICD-10-CM/PCS trainer. Dianna has held many positions in HIM and is now an independent coding consultant. She previously served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna is an AHIMA-published author and has volunteered with AHIMA on projects including certification item writing, certification exam development, coding rapid design, and most recently has served on AHIMA’s nominating committee. She is a presenter on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator. Dianna mentors new AHIMA members and also provides monthly educational lectures to coders and clinical documentation specialists.
