Social Determinants ICD10 Coding News

Although ICD codes for social risk factors such as homelessness and food insecurity exist, they are vastly underused, as documented in a study of social risk factor coding in the HCUP National Inpatient Sample database. (1) One reason they are underutilized is that up until early 2018, coders could only assign those codes if they were supported by physician documentation. Since physicians are rarely the ones documenting these factors, coders were limited in their ability to assign those codes.

Thanks to advocacy by a number of individuals, in early 2018, the AHA Coding Clinic published advice that allows the reporting of codes from categories Z55-Z65 based on information documented by all clinicians involved in the care of the patient, including non-physicians such as nursing staff, case/care managers, and social workers. This advice was approved by the ICD-10-CM Cooperating Parties* and will be incorporated into the next revision of the Official Coding Guidelines. This change was effective beginning Feb. 18, 2018. (2-3)

This should lead to improved availability of ICD10 social needs data from billing/claims datasets.

* The four organizations that make up the Cooperating Parties for the ICD-10-CM are the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), the Center for Medicare and Medicaid Services, and the National Center for Health Statistics.

(1) Torres JM, Lawlor J, Colvin JD, et al. ICD social codes: An underutilized resource for tracking social needs. Med Care. 2017; Epub ahead of print. PMID: 28671930. doi: 10.1097/MLR.0000000000000764.

(2) American Hospital Association. ICD-10-CM Coding for Social Determinants of Health. April 2018.

(3) Leon-Chisen N. ICD-10-CM and ICD-10-PCS Coding Handbook with Answers, 2018 Rev. Ed. American Hospital Association: Chicago, IL. 2018; 732 pages.