Social Determinant ICD-10 Codes Can Be Assigned Based on Non-physician Documentation

Social Determinant ICD-10 Codes Can Be Assigned Based on Non-physician Documentation

The American Hospital Association (AHA) recently reaffirmed that providers can assign social determinant codes in ICD-10-CM based on documentation from any member of the care team, including non-physicians such as social workers, case managers, nurses, and other allied staff.

This guidance, which was published in the first quarter 2018 issue of the AHA’s Coding Clinic for ICD-10-CM and ICD-10-PCS, had an effective date of February 18.

“These codes are not new codes,” Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director, coding policy and compliance at AHIMA, said. “They were already available in ICD-10-CM, but may have been under-utilized because coders thought they couldn’t assign the codes unless the patient’s physician documented the factors described by the codes. As noted in the AHA article, the factors and circumstances described by the codes are typically documented by healthcare professionals other than the physician, so the advice published in Coding Clinic was merely affirming that it is okay to report these codes if the only documentation to support them is from a non-physician.”

The codes, which in ICD-10-CM include categories Z55-Z65, identify persons with potential health hazards related to socioeconomic and psychosocial circumstances. Social determinants include societal and environmental conditions such as food, housing, transportation, education, violence, social support, health behaviors, and employment. As the AHA points out, studies have found numerous links between economic status, social factors, and physical environment as key influencers in health outcomes.

“Hospitals and health systems should educate necessary individuals, including physicians, non-physician health care providers, and coding professionals of the important need to collect data on the social determinants of health,” the AHA advises. “Utilizing these codes will allow hospitals and health systems to better track patient needs and identify solutions to improve the health of their communities.”

Mary Butler is the associate editor at Journal of AHIMA.

1 Comment

  1. I am glad you wrote this information. So many times in the past when I had completed medical abstract coding my superiors would frown at assigning Z diagnosis codes to match the physician notations of the treatment for the day. Also I had heard it does not help in raising reimbursement if adding the Z dx. codes or making it more detail and specific for the insurance payer. However assign a Z dx code as the first payer when it is a history or not a first listed dx code may lose reimbursement. In some payers eyes you may not get paid for doing claim sequencing wrong.

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