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ICD-10 permits non-physician providers to document social determinants — 6 insights

Healthcare organizations can use non-physician documentation to support ICD-10 coding for common socioeconomic issues not typically included in clinical diagnoses, according to the American Hospital Association.

Here are six insights:

1. Societal and environmental conditions are often documented by non-physician providers, such as case managers, discharge planners, social workers and nurses.

2. ICD-10 coders are typically only allowed to code factors that appear in physician, physician assistant and nurse practitioner documentation, so most hospitals and health systems are unable to report the codes.

3. As a result, the ICD-10-CM codes Z55 through Z65 have been infrequently utilized.

4. The change to allow the use of non-physician documentation to support coding for social determinants of health was included in the first quarter 2018 updates to official ICD-10 guidance.

5. The change may also help improve data collection on health literacy, housing and food security, interpersonal stressors and lack of social or community support. The social determinants could also help providers with chronic disease management, medication management and other conditions contributing to higher costs and poor long-term outcomes, according to HealthIT Analytics.

6. The code groups include:

  • Z55 – Problems related to education and literacy
  • Z56 – Problems related to employment and unemployment
  • Z57 – Occupational exposure to risk factors
  • Z59 – Problems related to housing and economic circumstances
  • Z58 – Problems related to physical environment (excluding occupational exposure)
  • 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
  • Z64 – Problems related to certain psychosocial circumstances
  • Z65 – Problems related to other psychosocial circumstances

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