In Summer of 2019 eHealth Initiative and UnitedHealthcares National Strategic Partnerships Division convened a collaborative meeting of leaders from payer organizations and other stakeholder groups to address the use of ICD-10-CM codes for capturing social determinants of health SDOH data. October 9 2019.
New Tool Helps Promote Icd 10 Codes For Social Determinants Of Health Data Healthcare It News
ICD-10-CM Code Category ProblemsRisk Factors Included in Category Z55 Problems related to education and literacy Z550 Illiteracy and low-level literacy Z551 Schoolingunavailable and unattainable Z552 Failed school examinations Z553 Underachievement in school.
Coding for social determinants of health. New Z-codes were proposed in April 2019 by UnitedHealthcare and the American Medical Association to add over 20 new Z codes under the existing social determinants of health SDOH categories Z55-Z651 An additional proposal was made by Blue Cross Blue Shield of Vermont and Yale School of Nursing to specifically add subcategory Z-codes related to food. Z55 Problems related to education and literacy. Social Determinants of Health Example.
Below are the SDoH Z Code categories from Chapter 21 of ICD-10-CM Persons with Potential health hazards related to socioeconomic and psychosocial circumstances. A patients health outcome might be affected by a wide variety of factors some of which can stem from their environment and surroundings. Social Determinants of Health ICD -10-CM Z Codes Z codes are a subset of ICD -10-CM diagnosis codes that represent factors influencing health status and contact with health services that may be recorded as diagnoses.
Of the 467136 Medicare FFS beneficiaries with Z code claims 334373 individuals 72 had hypertension and 248726 individuals 53 had depression. A listing of the ICD-10 codes applicable to SDOH can be found at the link below. Utilizing these codes will allow hospitals and health systems to better track patient needs and identify solutions to improve the health of their communities.
These types of influences called social determinants of health are gaining more visibility as healthcare providers and organizations look for methods to identify them and attempt to manage the bigger health picture that many. It offers additional detail than that listed above. ICD-10 Codes Pertaining to Social Determinants of Health.
ICD-10-CM categories Z55-Z65 are a more specialized group of codes to identify social determinants of health. Identifying documentation that would justify the assignment of an SDOH-related ICD-10-CM code. Coding for Social Determinants of Health SDOH and Adverse Childhood Experiences ACEs.
As coding professionals review a. Specifically Diagnosis or treatment significantly limited by social determinants of health is an example of Moderate risk of morbidity from additional diagnostic testing or treatment Providers should work with medical coders and auditors to ensure clear communication when it comes to SDOH that significantly limit diagnosis or treatment. When a social determinant of health is recognized provider offices include the related ICD-10 Code s when submitting a claim for a member affected by any of the applicable categories.
In accordance with the AHA 4 th Quarter 2019 issue of Coding Clinic identifying the categories of clinicians such as community health workers social workers and case managers whose health record documentation may be used for SDOH code assignment. SDOH-related Z codes ranging from Z55-Z65 are the ICD-10-CM encounter reason codes used to document SDOH data eg housing food insecurity transportation etc. The following is an example of a finding noted in the CMS Data Highlight.
A Social Determinants of Health Coding Collaborative Use Case Package Version 12 9302019 DISCLAIMER. Although these types of determinants may be documented within the medical record they may not always be coded by coders. Disparities Impact Statement.
Watch for further announcements about ICD-10-CM code changes regarding SDOH. Social Determinants of Health ICD-10-CM Coding for Introduction Hospitals and health systems are working to address their patients social needs and the broader social determinants of health in the communities they serve. Z65 Problems related to other psychosocial circumstances The American Academy of Pediatrics published a quick reference to social determinants of health coding which provides added detail for several determinants and a corresponding ICD-10 CM code description.
Physicians non-physician health care providers and coding professionals of the important need to collect data on the social determinants of health. Social Determinants of Health SDOH Data Journey to Better Outcomes. For social determinants of health such as information found in categories Z55- Z65 Persons with potential health hazards related to socioeconomic and psychosocial circumstances code assignment may be based on medical record documentation from clinicians involved in the care of the patient who are not the patients provider since this information represents social.
They can be things such as a history of physical abuse homelessness economic circumstances affecting health care social exclusion and rejection and problems related to education and literacy. Illiteracylow-level schooling availability failing school underachievement discord with teachers. This includes societal and environmental conditions such as.
This Use Case document was developed solely for informational and decisional purposes in the identification of coding standards for documenting and sharing social determinants of health data.
