SDoH Z Codes: How it Took a Village to Clear the Confusion
By Tiffany Ferguson, LMSW, CMAC, ACM
The Gravity Project and the American Medical Association (AMA) have taken a significant step toward clarifying the coding process for the social determinants of health (SDoH). Their partnership has resulted in the development of resources aimed at assisting coding professionals to help translate social risks such as housing and transportation deficits into the appropriate SDoH Z Codes.
The initial guide has taken the Centers for Medicare & Medicaid Services (CMS) Health-Related Social Needs (HRSN) Screening Tool, used primarily for social drivers of health requirements, and formatted each response into the appropriate code set. This resource includes suggested ICD-10-CM and SNOMED CT® codes for each question on the Accountable Health Communities (AHC) HRSN Screening Tool, as well as additional codes for more specific social risk dimensions and root causes that may emerge during patient screenings.
The significance of this collaborative endeavor cannot be overstated, as it comes at a time when healthcare organizations and hospitals are gearing up for the CMS Social Drivers of Health Measures mandatory reporting in 2024. This year, during the voluntary reporting, there have been many trials for how the five required questions for social drivers of health will be asked, and whose responsibility it will be to collect this information. Work has been underway for hospitals to figure out how to start coding these responses and learning about whether patient answers impact the patient’s hospitalization and/or outpatient services.
Per the press release, Corey Smith, AMA Vice President of Informatics and Digital Products (and Gravity Project Technical Director), emphasized the importance of scalable, automated tools for encoding health-related social risk data using ICD-10-CM and SNOMED CT. Such tools play a critical role in identifying and addressing evidence-based social risks that have a direct impact on health outcomes. This collaboration marks a significant stride toward achieving this goal with clear definitions.
The collaboration between the Gravity Project and the American Medical Association is a significant step forward in the ongoing effort to address the SDoH. By providing healthcare providers with valuable resources to document social risks in standardized terms, this initiative promotes better care and more effective interventions for patients, ultimately leading to improved health outcomes.
Here are a couple of example scenarios:
The patient has entered the hospital, and during their medical workup they have been identified as homeless. However, under further questioning, “what is your living situation today?” the patient states that they have temporarily been staying in a hotel.
The code would be Z59.01, Sheltered Homelessness.
A patient is expected to discharge home with new setup home O2; however, case management has learned that the patient does not have electricity in their home. This has delayed discharge because they are unable to accept a home O2 concentrator.
For this situation, code Z59.12 Inadequate housing, utilities would be used. As healthcare continues to evolve, this collaboration will ensure that clinical and coding professionals have the tools they need to successfully capture and code Z Codes.