Social Determinants of Health (SDOH) has recently become a main topic in the healthcare industry. With updates and expansions to ICD-10-CM and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the more recent approach is to medicalize social problems. National Claims Data shows that most healthcare providers do not currently code for Social Determinants of Health.
“Societal and environmental conditions such as food, housing, transportation, education, experiences, social support and employment that can affect a person’s health. Numerous studies have demonstrated a link between economic status, social factors, and physical environment as key influencers in health outcomes.” -The Centers for Disease Control and Prevention (CDC) definition of SDOH
SDOH codes can be found in ICD-10-CM code categories Z55-Z65. These codes describe conditions like poverty, homelessness, abuse, neglect, etc.
Payers often deny the SDOH codes as primary diagnosis, because they are classified in ICD-10-CM as “unacceptable principal diagnosis” codes.
There has been a lot of conversation around who can capture these SDOH data and the context that it can be used for coding and reporting. This bit of controversy tends to make providers not want to assign codes to patients that have SDOH factors.
SDOH codes are very important to capture the complexity of patient populations. These factors affecting a patient’s health can justify higher levels of evaluation and management services, risk adjustment payment methodologies, prolonged services, extended monitoring, etc. SDOH patients also typically lack stable phone and mailing resources, so the lack of continuity of care is an additional consideration the provider should be aware of.
SDOH ICD-10 codes are one of the few resources we share to measure and evaluate on a national scale. Medical coders can have a huge impact on this public health issue by educating healthcare providers about the importance of their clinical documentation to capture the accurate code assignment for SDOH.