• Register to Access the Free Forums and 3 Free CEUs!

    To view the content for the 3 free CEUs, please sign up today.

  • Missing Access To A Course, Blitz or Exam? Have Technical Issues? Open a Help Desk Ticket
    Please Do Not Post in the Community About Access or Technical Issues
    CCO Business Hours for Help Desk and Coaching: Mon-Fri 9am-4pm Eastern

Resource Coding for Social Determinants of Health

CD-10-CM Coding for Social Determinants of Health


Improving ICD-10-CM Coding for Social Determinants of Health​

Screen Shot 2021-06-15 at 7.47.17 AM.png
Screen Shot 2021-06-15 at 7.48.04 AM.png

eHI Explains ICD-10-CM Coding for Social Determinants of Health​

Screen Shot 2021-06-15 at 7.52.11 AM.png

ICD-10-CM Codes for Social Determinants of Health

CDC Social Determinants of Health

How Are Social Determinants of Health Codes Used?​

The data collected from claims with reported SDOH codes is being used by CMS to analyze data and health trends. This document by CMS highlights how CMS is using the data: https://www.cms.gov/files/document/cms-omh-january2020-zcode-data-highlightpdf.pdf

Does anybody know the financial impact of using these codes? Will it increase reimbursement? Any financial incentives to providers/agencies?
Health codes like these are not based on reimbursement. This is for statistics and MDM. That is why we code anyway. For statistical purposes, it happen to be a convient way to get paid. That being said, it does affecte MDM which is E/M and thus raises MDM and $$$.
The Medicare Physician Fee Schedule (MPFS) Proposed Rule for calendar year (CY) 2024, the Centers for Medicare & Medicaid Services (CMS) proposes to create five new HCPCS Level II codes to define and put a price on practitioners’ time and resources for determining and addressing patients’ SDOH.

Community Health Integration Services, Principal Illness Navigation Services & SDOH Risk Assessment.

CMS identifies these services in the proposed rule as:

  • Community health integration (CHI) services;
  • SDOH risk assessment; and
  • Principal illness navigation (PIN).
GXXX1 Community health integration services performed by certified or trained auxiliary personnel, including a community health worker, under the direction of a physician or other practitioner; 60 minutes per calendar month, in the following activities to address social determinants of health (SDOH) need(s) that are significantly limiting ability to diagnose or treat problem(s) addressed in an initiating E/M visit

GXXX2 Community health integration services, each additional 30 minutes per calendar month (List separately in addition to GXXX1)
GXXX3 Principal illness navigation services by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator or certified peer specialist; 60 minutes per calendar month

GXXX4 Principal illness navigation services, additional 30 minutes per calendar month (List separately in addition to GXXX3)
GXXX5 Administration of a standardized, evidence-based social determinants of health risk assessment, 5-15 minutes, not more often than every 6 months

It’s Official: CMS Recognizes Homelessness as a CC​

The rule also includes adjustments related to the social determinants of health (SDoH), recognizing the influence of social and economic circumstances on healthcare outcomes. Notably, the addition of homelessness as a coded CC is a step to support efforts to advance health equity.
The final ruling for Z59.00, unspecified homelessness, with subcategories of 59.01, and 59.02- sheltered and unsheltered homelessness.

These will now be considered a complication or comorbidity (CC), based on the higher average cost to care for such individuals.
CMS stated that on April 18, the Office of the National Coordinator proposed updating certification standards that if finalized, would require certified EHR vendors to include four SDoH data elements in their products: SDoH assessment, goals, interventions, and problems/health concerns.
Read More here: