Pulmonology Coding Alert

Question: I know there’s a huge push to document social determinants of health (SDOH) for patients, but I don’t really understand the point. The practice where I work sees a lot of folks who are struggling. It feels like we’re robbing them of their dignity to talk about it in their medical records. Why do we have to record that information?

West Virginia Subscriber

Answer: Documenting SDOH via ICD-10-CM codes is an important part of helping payers and other organizations determine a population’s well-being, said Kimberly Jolivette Williams, CPCO, CPC, CPB, CPMA, CANPC, CCC, CEMC, CEO and senior instructor at Jolivette MediCoding Institute LLC, in a presentation during AAPC’s REVCON.

Reporting SDOH with ICD-10-CM codes also impacts the appropriate allocation of funding for government-specific disease management programs.

Some health outcomes that could be influenced by SDOH include: healthcare access, financial security, education, housing, nutrition and food security, social support, cultural and social norms, work, transportation, and childhood stress.

Healthcare providers should document SDOH to justify their E/M level selection. The factors are part of the medical decision making (MDM) process, and when the provider understands circumstances affecting the patient’s care and treatment, the physician can use the SDOH elements to ensure an appropriate care plan. For example, if a patient is experiencing a financial hardship and is unable to cover the cost of a prescription, the provider can assign a medication that works for the patient and their budget.

Coders can contribute to the data collection about childhood poverty within a single practice, for example, and thus help influence big-picture relief measures for that issue across the country.

SDOH are not moral judgements of a person’s success in life, and recording such conditions simply provides context about how a person is living and what obstacles they might face.