Resource Coding for Social Determinants of Health

CD-10-CM Coding for Social Determinants of Health

https://www.aha.org/system/files/20...icd-10-code-social-determinants-of-health.pdf

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

Journal of AHIMA | Home

https://www.cms.gov/files/document/zcodes-infographic.pdf

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

https://www.ehidc.org/resources/ehi-explains-icd-10-cm-coding-social-determinants-health

• Where can I find more resources and initiatives around SDOH data and ICD-10-CM Coding?
  • American Hospital Association (AHA) Information sheet on ICD-10 Coding for Social Determinants of Health
  • "Health Disparities: Social Determinants of Health)” (Free online education module by the American Medical Association (AMA)
  • AMA’s Integrated Health Model Initiative (IHMI), Resource Link & Link 2
  • AMA and UnitedHealthcare’s collaboration to support the creation of new ICD-10 codes related to SDOH
  • Centers for Disease Control (CDC) Social Determinants of Health Webpage
  • CMS 2020 ICD-10-CM Files
  • CMS ICD-10-CM Official Guidelines for Coding and Reporting for FY 2020
  • CMS’ Accountable Health Communities Health-Related Social Needs Screening Tool & FAQ
  • Healthy People 2020’s Social Determinants of Health Webpage
  • Humana Food Insecurity and Loneliness Toolkits
  • The National Association of Community Health Centers (NACHC) Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE)
  • American Academy of Family Physicians (AAFP)’s EveryONE Project Toolkit
  • SIREN’s (Social Interventions Research and Evaluation Network) Gravity Project Resource Link & Link 2
  • NCQA Population Health Management Resource Guide

https://www.bcbsil.com/pdf/clinical/ICD-10_Z_codes_flier.pdf

ICD-10-CM Codes for Social Determinants of Health
file:///Users/lorijaramillo/Downloads/ICD%2010%20CM%20for%20SDOH_07.08.2020.pdf

CDC Social Determinants of Health

https://www.cdc.gov/nchs/data/icd/social-determinants-of-health.pdf

Social Determinants of Health and 2021 E&M Code Changes – MedLearn Publishing

New E&M codes will take effect Jan. 21, 2021. Our number one priority is supporting our healthcare organizations during the COVID-19 pandemic, yet we still must be aware of changes in the way E&M codes are assigned for office visits, based on new guidelines that will take effect on Jan. 1, 2021...

www.icd10monitor.com

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

Social Determinants of Health (SDOH)

Social determinants of health, oftentimes abbreviated as (SDOH) are the economic and social conditions in which people are born, live, grow, work and age in. They may impact a wide range of health and quality of life risks and outcomes for patients.

www.hiacode.com

 

[TheresaK_4456]

Hi,
Does anybody know the financial impact of using these codes? Will it increase reimbursement? Any financial incentives to providers/agencies?

 

[Alicia]

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 $$$.

 

[TheresaK_4456]

Hi Alicia,

Thank you for taking the time to answer my question. Have a wonderful day!

 

[Lori]

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

Capture Payment for Addressing Your Patients’ SDOH

CMS proposes to codify three services that aim to remove barriers to quality care. Healthcare practitioners, especially primary care providers, are 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...

www.aapc.com

 

[Lori]

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:

It’s Official: CMS Recognizes Homelessness as a CC – MedLearn Publishing

As reported back in April 2023 regarding the proposed ruling on social determinants of health (SDoH) Z-codes, I would like to update and celebrate the final ruling for Z59.00, unspecified homelessness, with subcategories of 59.01, and 59.02- sheltered and unsheltered homelessness. These will now...

icd10monitor.medlearn.com