Be Part of a Positive Change in Healthcare

Account for social determinants of health in your patients to ensure quality care.

The specificity of the ICD-10-CM code set enables us to paint a clearer clinical picture of our patient’s health status. Our healthcare systems have always kept a close eye on the prevalence and progression of chronic conditions such as diabetes, chronic obstructive pulmonary disorder, and morbid obesity. Now is the time to do more.

Address the Problem

2020 brought the COVID-19 pandemic, racial injustice, and unemployment to the forefront of our nation’s attention. These challenges highlighted some of the disparities we see in healthcare in the United States. Beyond a patient’s physical and mental health, we need to be aware of social determinants, so we are better prepared to offer equitable care to all patients.

“The most prevalent and severe health inequities occur where there is poverty, systematic racism, and discrimination. Some of the most common and well-researched health inequities are experienced between groups based on socioeconomic status, race and ethnicity, sexual orientation and gender expression, as well as geographic location.” (Berkman and Kawachi, 2000)

Report Health Status With Z Codes

Fortunately, ICD-10-CM allows us to report on a patient’s social determinants with the use of codes in range Z55-Z65.

Z55        Problems related to education and literacy

This category includes illiteracy and low level of literacy, failed school exams, underachievement in school, and educational maladjustment and discord with teachers and classmates.

Z56        Problems related to employment and unemployment

This category includes unemployment, change of job or threat of job loss, and discord with boss and workmates.

Z57        Occupational exposure to risk factors

This includes exposure to noise, radiation, dust and other contaminants, toxic agents, and extreme temperature.

Z59        Problems related to housing and economic circumstances

This includes homelessness, inadequate housing, discord with neighbors and landlord, lack of adequate food and safe drinking water, extreme poverty, low income, and insufficient social insurance and welfare support.

Z60        Problems related to social environment

This includes being the target of (perceived) adverse discrimination and persecution.

Z62        Problems related to upbringing

This includes children in welfare custody and inadequate parental supervision and control.

Z63        Other problems related to primary support group, including family circumstances

This includes relationship problems and absence of family members.

Z64        Problems related to certain psychosocial circumstances

This includes problems related to unwanted pregnancy.

Z65        Problems related to other psychosocial circumstances

This includes imprisonment and being the victim of crime and terrorism.

Consider the Source

There is no doubt that the story told by these codes is crucial to bridging gaps in healthcare. It is important to note that documentation of these conditions does not fall solely on the patient’s provider. The official ICD-10-CM guidelines state:

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 patient’s provider since this information represents social information, rather than medical diagnoses. Patient self-reported documentation may also be used to assign codes for social determinants of health, as long as the patient self-reported information is signed-off by and incorporated into the health record by either a clinician or provider.

2021 brings renewed hope for health, social justice, and economic stability. As professionals in the business of healthcare, we can be part of the positive change by ensuring disparities are captured in the data. Our traditional healthcare delivery system is not sufficient to take care of the whole patient. We need to look beyond chronic and acute conditions and document and report on the social, economic, and environmental factors that influence health. The solution is not an easy one; tracking these disparities is very complex because each person’s experience is unique and possibly impacted by several different categories.

Ask the Right Questions

There are many questions organizations should be asking and answering. For example:

• Are we reporting the SDOH codes?
• Who is collecting this information?
• What are we doing with the results of this reporting?
• Are there existing programs that can help a patient who has been identified with a need?
• Are new programs needed to support our patient or member population?

I challenge you to start the conversation within your organization and to be part of this much needed change.

Resources:

Berkman LF, Kawachi I, eds. Social Epidemiology. New York, NY: Oxford University Press; 2000.

2021 ICD-10-CM Guidelines for Coding and Reporting: https://www.cms.gov/medicare/icd-10/2021-icd-10-cm

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Colleen Gianatasio

Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I, CRC, CCS, CCDS-O, has over 20 years' of experience in the health insurance field, including customer service, claims, quality, and coding. As director of ambulatory CDQI at Mount Sinai Health Partners, her primary responsibilities are provider engagement and CDI for accurate coding and reimbursement. Gianatasio specializes in developing innovative coding curriculum and instruction to support compliance with federal guidelines and appropriate reimbursement processes. She is a certified AAPC instructor and enjoys teaching a variety of coding, documentation, and auditing classes. She serves as president-elect of the AAPC National Advisory Board.

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