News: SDOH codes are underutilized, according to ICD-10-CM study

CDI Strategies - Volume 15, Issue 6

A recent analysis of EHR data from 2015 to 2019 shows that providers underreported ICD-10-CM codes in categories Z55-Z65 for social determinants of health (SDOH).

SDOH are social factors, such as homelessness, illiteracy, a history of childhood trauma, and joblessness or underemployment, that can affect a person’s health and outcomes. Coding for these factors is important because CMS uses them to adjust quality measures for patients who are dual-eligible for Medicare and Medicaid. In addition, coding these factors may help shape future health policy.

2018 study found that ICD-10-CM codes for the SDOH are infrequently utilized in inpatient settings for discharges other than those related to mental health and alcohol/substance use. To further examine use of these codes, physicians at the University of Florida reviewed ICD-10-CM data from a large collection of EHRs in the OneFlorida Clinical Research Consortium (one of the 13 clinical data research networks funded by Patient-Centered Outcomes Research Institute). They reviewed 710 million patient encounters with dates of service between 2015 and 2019 and tallied the number of encounters that included ICD-10-CM codes Z55-Z65.

The researchers found that Z-code utilization was very low considering the published rates of certain social problems. For example, according to the U.S. Census Bureau's 2017 American Community Survey, an estimated 1.9% of Floridian adults reported a fifth grade or lower education. In contrast, only 0.31% of the adult patients in the OneFlorida network received a code from ICD-10-CM category Z55.-, Problems related to education and literacy, between 2015 and 2019. 

In the 710 million encounters identified, the overall Z-code utilization rate was only 270.61 per 10,000 encounters. Notably, this rate increased in 2018 from 255.62 to 292.79 per 100,000 encounters after the ICD-10-CM Cooperating Parties added new guidance for reporting SDOH to the ICD-10-CM Official Guidelines for Coding and Reporting. The guidance clarified that ICD-10-CM codes from categories Z55-Z65 can be assigned based on information documented by all clinicians (not only physicians) involved in the care of the patient.

According to the researchers, these findings demonstrate the continued need to educate providers on screening and coding for the SDOH.

Editor’s note: This article was originally published in JustCoding. To read more about how CDI professionals can help ensure proper SDOH documentation, click here.

Found in Categories: