Primary Care Coding Alert

Question: I’m reading all about the importance of reporting social determinants of health (SDoH) in a medical record, but I haven’t focused much on these codes until now. How do I know which one(s) to report?

Georgia Subscriber

Answer: You’ll find all the codes you need to report SDoH in the Z55-Z65 (Persons with potential health hazards related to socioeconomic and psychosocial circumstances) group of codes. Many of the key codes you might need for reporting SDoH can be found in the following code groups:

• Z55.- (Problems related to education and literacy)
• Z56.- (Problems related to employment and unemployment)
• 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, including family circumstances)

Expert coding tip: Before using one of the Z55-Z65 codes, be sure you become familiar with the main ICD-10 guideline that governs their use. Per I.B.14, codes in categories Z55-Z65 “should only be reported as secondary diagnoses.” Plus, Z55-Z65 are some of the only codes in ICD-10 that you can report “based on medical record documentation from clinicians involved in the care of the patient who are not the patient’s provider.” That’s because “this information represents social information, rather than medical diagnoses,” as the guidelines (I.C.21.c.17) go on to elaborate.

So, you can use documentation “from social workers, community health workers, case managers, or nurses, if their documentation is included in the official medical record,” and “patient self-reported documentation … to assign codes for social determinants of health, as long as the patient self-reported information is signed-off by and incorporated into the medical record by either a clinician or provider,” per ICD-10 Official Guidelines.