Social Determinants of Health (SDOH) ICD-10 Codes: What They Mean For Healthcare Clinicians, Quality Measures, & Coding

Social Determinants of Health (SDOH) ICD-10 Codes: What They Mean For Healthcare Clinicians, Quality Measures, & Coding

The concept of Social Determinants of Health (SDOH) has been increasingly recognized as a crucial factor in influencing health outcomes. As healthcare initiatives and coding practices continue to evolve, the implementation of SDOH ICD-10 diagnosis codes has gained prominence, reflecting the growing emphasis on addressing social factors to improve overall health and well-being. In this context, healthcare clinicians need to understand the significance of SDOH ICD-10 codes, their impact on quality measures, and the evolving requirements for documentation and reporting.

Recently, the CDC adopted this definition of social determinants of health (SDOH) from the World Health Organization (WHO):

“SDOH are the nonmedical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age. These forces and systems include a wide set of forces and systems that shape daily life such as economic policies and systems, development agendas, social norms, social policies, and political systems.”

Why are the SDOH ICD-10 Diagnosis Codes Important Now?

The U.S. Department of Health and Human Services established the Healthy People 2030 national objective to improve health and well-being over the next decade. This initiative is data-driven by SDOH, affecting a wide range of health, functioning, and quality-of-life outcomes and risks.

SDOH can be grouped into five domains:

• Economic Stability
• Education Access and Quality
• Health Care Access and Quality
• Neighborhood and Built Environment
• Social and Community Context

Some of the examples of SDOH outlined in the Healthy People 2030 initiative include safe housing, transportation, polluted air and water, access to nutritious foods, and language and literacy skills.

Providers, take note: Beginning in 2024, hospitals participating in the Inpatient Quality and Reporting Program must report screening for social drivers of health and hospital commitment to Health Equity quality measures. The HHS has shared some key actions that health and social care providers can take to aid in this initiative.

Additionally, under the calendar year 2024 Physician Fee Schedule Final Rule, Medicare will separately pay for SDOH risk assessments.

Various clinicians need to document the assessment of SDOH. Several screening tools are available in Electronic Health Records (EHR), and the CMS also developed an SDOH screening tool.

Other examples of SDOH assessment screening tools include:

• https://sirenetwork.ucsf.edu/sites/default/files/Your%20Current%20Life%20Situation%20Questionnaire%20v2-0%20%28Core%20and%20supplemental%29%20no%20highlights.pdf
• https://www.aamc.org/system/files/c/2/442878-chahandout1.pdf
• https://www.aafp.org/dam/AAFP/documents/patient_care/everyone_project/hops19-physician-form-sdoh.pdf

Documenting & Reporting the Social Determinants of Health ICD-10 Codes

Once the SDOH screening assessment is completed (either manually scanned or digitally entered within the EHR), medical coders need to capture the SDOH. Each facility may decide which categories to prioritize for coding, as most of these types of ICD-10-CM diagnosis codes were not previously captured. Now, it is important for the coding department to receive directives from their leadership.

Social determinants of health ICD-10-CM diagnosis codes are located primarily in these Z code categories:

The ICD-10-CM Official Coding Guidelines state:

“For social determinants of health classified to chapter 21, 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.

“For example, coding professionals may utilize documentation of social information from social workers, community health workers, case managers, or nurses, if their documentation is included in the official medical record.

“Patient self-reported documentation may 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 medical record by either a clinician or provider.”

Social Determinants of Health ICD-10 Codes Will Affect Reimbursement

Another reason to assign SDOH ICD-10-CM diagnosis codes – beyond the HHS Healthy People 2030 initiative and the requirement for participating in the Inpatient Quality and Reporting Program – is that these assignments may affect reimbursements. Currently, the SDOH codes for Z59.00 Homelessness unspecified, Z59.01 Sheltered homelessness, and Z59.02 Unsheltered homelessness are all considered as Complications/Comorbidities (CC) within the MS-DRG system, which increases reimbursement.

The FY 2025 IPPS Final Rule for October 1, 2024, has added the following additional SDOH codes as CCs as well:

In conclusion, integrating Social Determinants of Health ICD-10 diagnosis codes has become increasingly important in healthcare practices and quality measures. It is of the utmost importance for healthcare providers, facilities, and coders to stay updated and informed regarding SDOH ICD-10-CM code assignments, requirements, and benefits.

As healthcare providers adapt to these changes, the proper documentation and reporting of SDOH will improve patient care and address health disparities. Our experienced coding consultants and inhouse HIM education experts are here to assist providers in navigating the complexities of these new codes, ensuring compliance and accuracy in capturing SDOH information and ultimately contributing to enhanced patient care.