The old rule led to the valuable codes being underused.
A rule requiring that physicians enter ICD-10 codes related to social determinants of health inadvertently caused them to be underused, but that might be about to change.
Hospitals and other providers should now have an easier time documenting social determinants of health thanks to a recent change in the rules governing ICD-10-CM.
A growing body of scientific literature suggests that social determinants—such as economic status, literacy, home environment, and social environment—can have major effects on a person’s health. Such factors are addressed in ICD-10-CM through codes Z55-Z65, which physicians can use to identify patients who could face health challenges as a result of socioeconomic or psychosocial factors.
The problem, according to Nelly Leon-Chisen, RHIA, director of coding and classification at the American Hospital Association, is that those codes have generally been under-utilized.
Leon-Chisen told Healthcare Analytics News™ the problem became clear in conversations with member hospitals.
“Many hospitals are developing strategies to address social determinants of health in their communities and recognize that screening and documenting this information about patients would help support their strategies,” she said. “Yet our members shared that one of the primary barriers to using the codes is that they could only be documented by a physician.”
Members told Leon-Chisen it would be much more feasible to collect such data if other clinicians were able to enter the information. Leon-Chisen and colleagues took that to heart and convinced the National Center for Health Statistics, the American Health Information Management Association, and the Centers for Medicare & Medicaid Services to agree to allow the codes to be used based on documentation by all clinicians. The change became effective in February, and the AHA outlined the details in a recent announcement.
Now that the rule change has been made, there’s still work to be done to ensure healthcare workers regularly obtain and record the data.
Leon-Chisen said conversations about social determinants of health are a new aspect of patient encounters for most providers. As such, physicians and other clinicians aren’t used to asking these kinds of questions.
“These are really sensitive topics that need to be approached in a thoughtful and sensitive way,” she said. “If the patient screens positive for a social determinant of health, clinicians need to know what to do next. There needs to be a system of care built around these patients that can help address their medical and social needs.”
If providers do a better job of documenting social determinants, the potential upside for healthcare is vast, according to Priya Bathija, JD, vice president for The Value Initiative at AHA.
“On the individual level, it will help clinicians better understand the social needs of their patients and refer them to the appropriate resources that can support their health—and prevent readmissions,” she told Healthcare Analytics News™. “In aggregate, the [social determinants of health] information can provide a picture of the social needs of the community, highlighting specific neighborhoods or geographies to focus services around.”
Bathija also said the data can help hospitals craft Community Health Needs Assessments and develop programs to improve healthcare at a community level.
“Integrating data collection and coding into a robust social determinants strategy can catalyze connections with community organizations to work toward a shared goal—healthier people and communities,” she said.
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