A summary of high-level takeaways regarding the new ICD-10 codes for social determinants of health:
- There are already 11 codes related to social determinants of health (SDOH) available for use by medical professionals. These are codes Z55 – Z65 in the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). However, these codes are currently poorly utilized by providers, partially because there are 68,000 codes in the database. An initiative to increase the use of these codes became effective in February 2018. This two-pager from the American Hospital Association is a helpful resource.
- The current purpose of coding for SDOH is primarily related to data collection and referrals. Using the codes can help give a more complete picture of what is going on with the patient in the medical record. In addition, the codes can be used to more appropriately refer patients to the resources they need. For example, UnitedHealthcare’s Medicare Advantage is sited to have used this data to make more than 700,000 social service referrals since 2017. It does not seem like ICD-10 codes have been tied to reimbursement yet.
- The American Medical Association (AMA) and United Healthcare are partnering to propose 23 new ICD-10 codes related to SDOH. These new codes would expand on the 11 existing codes and encompass social determinants including food, housing and financial insecurity. If approved, the new codes would go into effect in October 2020.
- The Centers for Medicare and Medicaid Services (CMS) final rule that was just announced on April 1st. The rule allows specifically Medicare Advantage plans flexibility to cover benefits that address SDOH in 2020. This can include costs such as for fresh produce for members with heart disease!
AHA ICD-10-CM Coding for Social Determinants of Health
AMA New ICD-10 Codes will Help Physicians Tackle Social Barriers to Care
AHIMA Group Propose New Social Determinant ICD-10 Codes
HealthcareDive United Healthcare, AMA Team Up on Billing Codes for Social Determinants
HealthcareDive CMS Finalizes Nontraditional MA Benefits, Use of Encounter Data