Groups Propose New Social Determinant ICD-10 Codes

The American Medical Association (AMA) and United Healthcare have proposed more than 20 new ICD-10 codes for social determinants of healthcare that identify social diagnoses or barriers to healthcare, according to the Centers for Disease Control and Prevention (CDC).

The proposed expanded codes “would capture these social diagnoses and barrier situations to assist providers and consumers in obtaining routine care, medications, and preventive services that are not captured today, thereby benefiting the industry as a whole in the management of patient care,” states the United Healthcare and AMA proposal in a document made available by the CDC.

The codes, which were discussed at a recent ICD-10 Coordinating and Maintenance Committee meeting, are not to be confused with existing ICD-10-CM codes, which include categories Z55-Z65, and help identify persons with potential health hazards related to socioeconomic and psychosocial circumstances. Last year the American Hospital Association reaffirmed that providers other than physicians who document in a patient’s record—such as social workers, nurses, and other allied health staff—can also assign social determinant codes.

Social determinants include societal and environmental conditions such as food, housing, transportation, education, violence, social support, health behaviors, and employment, which are attributes that contribute to an individual’s inability to access appropriate healthcare for their conditions.

According to a joint statement from United Healthcare and the AMA, “By combining traditional medical data with self-reported (social determinants of health) data, the codes trigger referrals to social and government services to address an individual’s unique needs, connecting them directly to local and national resources in their communities.”

There is no guarantee that these new codes will be approved, according to AHIMA’s Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director, coding policy and compliance.

“We won’t know if the requested codes will be approved until next year. If approved, they would go into effect October 1, 2020. I doubt that all of the requested codes will be approved, as some of the codes are very subjective, ill-defined, and/or ambiguous,” Bowman said.

The CDC has an open comment period on the proposed codes with a deadline of May 10.

For more highlights of the code proposals from the March 5-6 meeting of the ICD-10 Coordination and Maintenance Committee and the National Center for Health Statistics/Centers for Disease Control and Prevention, click here to read Bowman’s recent Under the Dome column.

Mary Butler is associate editor at Journal of AHIMA.

1 Comment

  1. I would also encourage reviewing the proposal on food insecurity submitted by the Blue Cross Blue Shield of Vermont and the Yale School of Nursing and supported by a number of organizations. As noted in the proposal, the current code (Z59.4) does not specifically represent food insecurity which makes tracking of this concept of concern impossible with ICD-10-CM.

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