Understanding the Need to Incorporate SDoH Codes in Facility Guidelines

Your facility coding guidelines should be clear as to what information may be used to determine SDoH codes.

Many payers are utilizing data for the creation of policies and the development of social programs. The buzz is that the social determinants of health (SDoH) data is not being reported, so it is not available to assist in making decisions. Payors are developing programs based on what they are hearing from the public. Hospitals are also reaching out to the public to assist with housing, transportation, and food access.

These activities impact the coding function. How do coders know which of these SDoH codes to assign? Does your facility have programs in place to address the SDoH? If so, the activities should be captured in the coded data. If you are not sure, you may need to talk with various areas to determine what information would be important to capture to support the activities. The areas that may be the most involved include your boss, case management, human resources, nursing, revenue cycle, etc. Once you have determined what SDoH activities are important to your hospital and your payers, then include the information in your facility-specific coding guidelines.

Other issues include who should document SDoH information, and where to maintain this information in the chart. The April 2023 ICD-10-CM Coding and Reporting Guidelines do provide some input regarding these questions. See I.C.21.C.17 – Social Determinants of Health in the guidelines, which include the provision that clinicians other than the patient’s provider may document these conditions in the health record. Information provided directly from the patient must be co-signed by a provider. The guidelines do not specify how the information should be documented. Some organizations have used a questionnaire completed by social workers or case managers to document SDoH information. That approach raises the question of if the provider should co-sign. The guidelines also include that if there is any conflicting information, the provider should be queried. Your facility-specific coding guidelines should be clear regarding what information may be used to determine and assign SDoH codes.

If you are using this information to determine a diagnosis code, then the documentation should be part of the patient’s legal medical record. The documentation is not limited to one specific place in the medical record, but you do want the record to be consistent regarding where the information may be found.

Correct code assignment involves a team to obtain the most accurate information. The team includes nursing, case management, clinical documentation integrity, social workers, utilization review nurses, providers, and coders.

The team is important to determine if the SDoH impact the patient’s care.

Programming note: Listen to Laurie Johnson’s Coding Report Tuesdays on Talk Ten Tuesdays with Chuck Buck and Dr. Erica Remer, 10 a.m. EST.