New Z codes also aimed at reducing hospital readmissions.

The one thing that medicine does not have enough of is abbreviations. So allow me to introduce the RACmonitor audience to another one: SDoH. I am sure many of you are aware of the social determinants of health (SdoH), but for those who aren’t, these are the non-medical factors that affect a person’s health. I don’t think anyone would disagree that a patient with multiple medical problems who is supposed to be taking six medications, including insulin injections, is going to face many more challenges if they are also homeless. Their homelessness is a significant social determinant that has profound effects on their health. So why did I talk about this on Monitor Monday? Shouldn’t it be a topic for Social Worker Saturday?

Well, because SDoH affect a hospital’s readmission rate, length of stay, cost per episode of care, use of post-acute care, and so on. Just recently the Centers for Medicare & Medicaid Services (CMS) has started making an adjustment in the hospital readmission reduction program to account for the percent of a hospital’s patients who are dual eligible—that is, they have Medicare and Medicaid. But other than that, there are no adjustments made for any other social factors, despite their tremendous influence on patient care processes and outcomes.

But there is a groundswell of interest in SDoH, so researchers are looking at data and payers are considering the effects these factors have on patients. In fact, you may have heard that CMS is going to allow Medicare Advantage plans to start addressing their patient’s social determinants by offering non-medical services such as supplying groceries, paying for air conditioning, providing transportation to appointments, and so on.

So as SDoH start to play a bigger role in a hospital’s reimbursement, the only way that the hospital’s data can be adjusted for these social determinants is if the appropriate ICD-10 code is on the claim. So why was I talking about ICD-10 coding on Monitor Monday and not Talk Ten Tuesday? Because a diagnosis can only be coded if it is documented. And that’s where the readers of RACmonitor all come in.

In February, the coding rules were changed by the American Hospital Association so that documentation of SDoH by any caregiver, including case managers and social workers, can now be used to assign a code and report it on the claim. There are actually 88 assignable ICD10 codes in the Z55 to Z65 range, including codes like homelessness, low income, stressful work environment, low literacy, divorce, personal history of abuse, and many more. There is even a code for the millennials: Z62.1- parental overprotection.

I doubt all 88 codes will be used for risk adjustment, but we won’t know which will be used, so we should document and code all applicable conditions. And the more a code is used, the more the researchers will realize it is a factor for them to consider.

We have the codes. We have permission to use the codes. Now it’s up to you to start documenting and asking your coding colleagues to start reporting. You’ll be hearing more about this in the coming weeks from one of my favorite social workers, Ellen Fink-Samnick, on Talk Ten Tuesdays, June 5, 2018, 10-10:30 a.m.


Program Note

Listen to Dr. Hirsch every Monday on Monitor Mondays, 10-10:30 a.m. EST.


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