The Industrial Revolution in the 19th Century signaled the change in how we live, setting in place the need to observe and compile information on how socioeconomic factors impact our health. In 2000 the World Health Organization (WHO) set into motion the tracking and trending of SDOH involvement in disease processes. Numerous agencies and organizations got on board, and in 2015 ICD-10 CM codes included “Z” codes for data collection.
Domains, categories, groups and risk have been associated with SDOH discussions; however, the bottom line involves people. How people live and work and age; how they are entertained and practice their faith. Education, employment or the lack thereof, insurance, access to electronics, utilities, the internet all express how we are navigating life’s journey. Healthy outcomes are broadly attributed to 80 to 90 percent of the SDOH: health-related behaviors, socioeconomic factors, and environmental factors. For this reason, it is important for physicians and healthcare professionals to document factors contributing to and impacting populations. It is just as important for coders to look for the documentation and assign the appropriate ICD-10 CM diagnosis code that best represents the SDOH.
SDOH codes do not require physicians to document the factors of social health to code them. They can be assigned based on documentation by other non-physician disciplines involved in the patient’s care. Self-reported documentation is also acceptable when provided by the patient or guardian if the information is a part of the medical record and approved by a clinician or provider. It is important to work with your administration and providers to consistently document any socio-economic factors influencing health.
Examples of each SDOH are below:
Z55 Problems related to education and literacy:
Z55.0-Z55.9
Z55.5 (Less than a high school diploma/ no GED)
Z55.6 (Difficulty understanding health related information or medical instructions)
Z56 Problems related to employment and unemployment:
Z56.0-Z56.9
Z56.0 (unemployment)
Z56.82 (military deployment status (civilian or military deployment) (Z91.85 is personal history of military service/veteran)
Z57 Occupational exposure to risk factors
Z57.0-Z57.9
Z57.0 (occupational exposure to noise)
Z57.4 (occupational exposure to toxic agents in agriculture)
Z58 Problems related to physical environment:
Z58.6-Z58.89
Z58.6 (inadequate drinking water supply)
Z58.81 (basic services unavailable in physical environment (internet, telephone and utilities)
Z59 Problems related to housing and economic circumstances
Z59.00-Z59.9
Z59.00 Homelessness, unspecified (cc)
Z59.01 (sheltered homelessness-doubled up, motel, scattered site housing, temporary, transitional) (cc)
Z59.02 (unsheltered homelessness- abandoned building, car, park, sidewalk, on the street) (cc)
Z59.11(inadequate housing- lack of air conditioning/heating)
Z59.12 (inadequate housing utilities -lack of electricity/gas/oil/water)
Z59.19 (other inadequate housing – pest infestation, space restriction)
Z59.41 (food insecurity)
Z59.71 (no health insurance)
Z59.82 (transportation insecurity)
Z60 Problems related to social environment
Z60.0-Z60.9
Z60.3 Acculturation difficulty (problem adapting to a different culture or environment)
Z62 Problems related to upbringing
Z62.0-Z62.9
Z63 Other problems related to primary support group, including family circumstances
Z63.0-Z63.9
Z64 Problems related to certain psychosocial circumstances
Z64.0-Z64.4
Z65 Problems related to other psychosocial circumstances
Z65.0-Z65.9
The SDOH code assignments are POA exempt, as well as unacceptable as the principal diagnosis/first listed diagnosis. Some are designated acceptable for adult use, others for pediatric use. There are three SDOH codes that will group to a comorbid condition (cc), Z59.00, Z59.01, Z59.02. Since comorbid conditions impact reimbursement as a result of increased resource consumption during patient care, it is important to ensure the SDOH condition(s) are documented in the record.
In capturing the socioeconomic conditions documented in the record, observed data will become information that can be used to make a difference in population health. Identifying at risk patients will enable better access to healthcare, reduce readmissions and reduce healthcare costs by providing quality healthcare to all populations. Now is the time to work with your providers and payers to document, capture and compile this valuable data.
Examples of Adding the documented SDOH impacts SOI/ROM and MS-DRG RW:
REFERENCES:
https://nam.edu/social-determinants-of-health-101-for-health-care-five-plus-five/
https://www.census.gov/history/www/census_then_now/
February 2023 SDOH: Survey Results on the Collection, Integration, and Use
https://www.ahima.org/media/03dbonub/ahima_sdoh-data-report.pdf
https://www.ahrq.gov/sdoh/about.html
https://www.cms.gov/priorities/health-equity/minority-health/equity-programs/framework
