Social risk factors can lead to unmet social needs that directly influence an individual’s physical, psychosocial, and functional status. These are broadly referred to as social determinants of health (SDOH). While SDOH do not currently risk-adjust for quality-of-care measures, they do help create an accurate clinical scenario and can impact discharge planning. To accurately represent patient acuity under CMS risk-adjustment methodology, document a diagnosis for each of the related conditions.
ICD-10 can capture SDOH in the following categories:
- Problems related to education and literacy
- Problems related to employment and unemployment
- Occupational exposure to risk factors
- Problems related to physical environment e.g., inadequate drinking-water supply o Problems related to housing and economic circumstances that may include:
- Sheltered or unsheltered homelessness
- Food insecurity
- Extreme poverty
- Transportation insecurity
- Problems related to social environment
- Problems related to upbringing e.g., child in welfare custody
- Other problems related to primary support group, including family circumstances
- Problems related to certain psychosocial circumstances
- Problems related to other psychosocial circumstances
- Do not need to be documented by the provider but may be missed by coding if only present in nursing notes.
- Can be documented by nursing staff, social workers or other clinicians, so coding must have access to review these documents.Should only be assigned when documentation specifies the patient has an associated problem or risk factor e.g., not everyone living alone has problems related to living alone.
- SDOH
- Do not need to be documented by the provider but may be missed by coding if only present in nursing notes.
- Can be documented by nursing staff, social workers or other clinicians, so coding must have access to review these documents.
- Should only be assigned when documentation specifies the patient has an associated problem or risk factor e.g., not everyone living alone has problems related to living alone.
- Examples
- Documentation by a clinician (or patient-reported information that is signed off by a clinician) that the patient expressed concerns with access and availability of food would support assignment of code Z59.41, Food insecurity.
- Documentation indicating the patient is homeless would support assignment of a code from subcategory Z59.0-, Homelessness.
- Examples
Reference: ICD-10-CM Official Guidelines for Coding and Reporting, April 1, 2023 update
