Posted January 5, 2023
Social Determinates of Health (SDOH) are currently trending in the coding and OASIS world. You may be asking yourself, “What is SDOH?”
Social Determinants of Health are the conditions in which people live, work, learn, and play. These conditions can impact a range of health risks and outcomes by playing a role in the patient’s ability to access nutritional food, live in a safe environment, afford transportation to visit a healthcare provider, understand and adhere to medication instructions and a host of other factors related to one’s socio-economic status. The recent focus on diversity, equity and inclusion has brought to light just how great an effect SDOH can have on an individual’s health and now more than ever home care is uniquely positioned to collect this data.
Documenting SDOH
Documentation of a patient’s SDOH factors is now required for OASIS E. If you are responsible for overseeing coding and compliance in your organization, now is the time to educate clinicians on SDOH documentation and assessments. Identifying SDOH, which includes access to health care, social status, education/health literacy, living environments and culture, helps clinicians and payers understand how socio-economic factors impact the patient’s outcomes. Home health clinicians see patients from the intimacy of their homes and can identify things like poor living conditions or lack of social support. Armed with this information, providers can more effectively care for underserved populations and address these SDOH factors to improve outcomes. The inclusion of SDOH items in the OASIS E update will be a great help in collecting this data.
Coders’ education is the first step toward better health for underserved populations. Because the SDOH criteria are a new addition to OASIS, coders are unfamiliar with the social needs criteria and lack definitions provided for each code. With training, your coders will know the codes that represent these defined needs and how to use them appropriately. With proper instruction, coders will be able to read patient narratives thoroughly and interpret the context as they are coding.
SDOH Codes and Their Meaning
The code I.C.21.c.17 describes problems or risk factors related to social determinants of health, and this code should be assigned when SDOH is documented.
- Assign as many SDOH codes as are necessary to describe all the problems or risk factors.
- Only assign codes when the documentation specifies that the patient has an associated problem or risk factor.
Individual categories Z55-Z65 describe specific conditions. Coders should become familiar with these parent categories along with the subcategories which will describe each specific situation.
- Z55 Problems related to education and literacy
- Z56 Problems related to employment and unemployment
- Z57 Occupational exposure to risk factors
- Z58 Problems related to physical environment
- Z59 Problems related to housing and economic circumstances
- Z60 Problems related to social environment
- Z62 Problems related to upbringing
- Z63 Other problems related to primary support group
- Z64 Problems related to certain psychosocial circumstances
- Z65 Problems related to other psychosocial circumstances
Proper SDOH Coding Promotes Better Care
Codes describing social determinants of health must be assigned whenever this information is recorded or described by a patient or clinician because it is now required. Code assignment may be based on a clinician’s report who is not the patient’s provider since this information represents social information rather than a medical diagnosis. SDOH can be patient-reported if the information is signed-off and incorporated into the medical record by a clinician or physician who can authenticate it.
With proper education and accurate recording of validated SDOH factors, clinicians and coders alike will share the responsibility to help document the patient’s needs. Accurate assessment of the patient’s SDOH allows providers to identify solutions, create a plan of care to address specific needs and positively impact health for individuals in their care and, ultimately, the communities in which they reside.
More than ever before, accurate ICD-10 coding is critical for getting the reimbursement you deserve under the Patient-Driven Groupings Model (PDGM). Boost compliance, save your staff valuable time and reduce administrative costs by contacting Corridor to access our coding and clinical documentation review.
About Corridor
For over 30 years, Corridor has partnered with home-based care providers, delivering powerful solutions to support the unique challenges of caring for patients in the home. Our team of operating executives, clinicians, and nationally renowned industry experts have run provider organizations and resolved the same challenges you face.
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