Hospitals allowed to use nonphysician documentation to support coding for social determinants of health

The American Hospital Association has worked to change rules governing reporting of social determinants of health.

Social determinants include food, housing, transportation, education, violence, social support, health behaviors, and employment, among other societal and environmental conditions. To report such issues, hospitals and health systems use ICD-10-CM codes included in categories Z55-Z65. The categories include "problems related to education and literacy," "problems related to employment and unemployment," and "occupational exposure to risk factors," among others.

While these codes were available, coding professionals could only report them if there was supporting physician documentation, according to the AHA, which cites the ICD-10CM Official Guidelines for Coding and Reporting. This means hospitals and health systems could not report societal and environmental conditions if documentation was supported by nonphysician providers, such as case managers, discharge planners, social workers and nurses.

But the AHA has unveiled a change that resulted from its work. The association said the ICD-10-CM Cooperating Parties, including the American Health Information Management Association, the AHA, CMS and the National Center for Health Statistics, approved advice published by the AHA Coding Clinic that allows hospitals to report ICD-10-CM codes included in categories Z55-Z65, based on documentation from all involved caregivers, including nonphysicians. That change took effect Feb. 18 of this year.

The change comes as research has shown social determinants of health affect patients' vulnerability to health issues. 


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