Knowledge Base Article

In late June, the FY 2022 ICD-10-CM diagnosis code updates were posted to the CMS website (link) and the CDC website (link). Since then, the CDC updated their announcement on July 2, 2021. Specifically, they advise, if you downloaded the following two documents prior to June 30, 2021, you would need to download them again:

• A new version of the ICD-CM-tabular addenda for FY 2022 has been added to correct the missing I5A, Non-ischemic myocardial injury (non-traumatic) code for the addenda, and
• A new version of the FY 2022 Conversion table has been added.

Social Determinants of Health (SDOH)

Of the 159 new codes for FY 2022, I want to focus on the code additions to code categories Z55-Z65. These codes identify persons with potential health hazards related to socioeconomic and psychosocial circumstances.

Social Determinants of Health Defined

The World Health Organization defined SDOHs as being “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national, and local levels. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries.”

New and Revised SDOH Z Codes for FY 2022:

• Z55.5 Less than a high school diploma
• Z58 Problems related to physical environment
• Z58.6 Inadequate drinking-water supply
• Z59.00 Homelessness unspecified
• Z59.01 Sheltered homelessness
• Z59.02 Unsheltered homelessness
• Z59.4 was revised from “Lack of adequate food and safe drinking water” to
• Z559.4 “Lack of adequate food”
• Z59.41 Food insecurity
• Z59.48 Other specific lack of adequate food
• Z59.81 Housing instability, housed
• Z59.811 Housing instability, housed with risk of homelessness
• Z59.812 Housing instability, housed, homelessness in past 12 months
• X59.819 Housing instability, housed unspecified
• Z59.89 Other problems related to housing and economic circumstances

Coding Clinic Guidance

A question was asked, in Coding Clinic for ICD-10-CM/PCS, First Quarter 2018, to verify whether these Z codes could be assigned based on non-physician documentation. Advice provided indicated that these codes represent social information, and it would be acceptable to report them based on documentation from other clinicians following the patient.

ICD-10-CM Official Guidelines for Coding and Reporting

Guidance related to coding SDOH category Z codes first appeared in the FY 2019 ICD-10-CM Official Coding Guidelines in Section B.14: Documentation by Clinicians Other than the Patient’s Provider:

“For social determinants of health, such as information found in categories Z55- Z65, Persons with potential health hazards related to socioeconomic and psychosocial circumstances, code assignment may be based on medical record documentation from clinicians involved in the care of the patient who are not the patient’s provider since this information represents social information, rather than medical diagnoses.”

In FY 2021, the following additional statements was added to the guidelines:

“Patient self-reported documentation may also be used to assign codes for social determinants of health, as long as the patient self-reported information is signed-off by and incorporated into the health record by either a clinician or provider.”

CMS Acknowledges Impact of SDOH on Health

In January of this year, CMS issued guidance to state health officials to drive the adoption of strategies addressing SDOH in Medicaid and the Children’s Health Insurance Program (CHIP) to help improve beneficiary outcomes. CMS ends a related Press Release (link) by indicating that they have “placed an emphasis on addressing SDOH across all of its programs in its continued efforts to move toward a value-based model of care delivery.”

With the addition of new ICD-10-CM codes specific to SDOH, hospitals could assist in identifying “at risk” patient. Hospital coding professionals should be aware of these codes and look to documentation by a Social Worker, Case Manager, or the admitting nurse as socioeconomic issues can be identified as part of the admission history and discharge planning process.

If you are interested in learning more about SDOH, visit the CDC’s SDOH website (link) that will connect you to CDC resources for SDOH data, research, tools for action, programs and policy.