Social Determinants of Health and Medical Coding

If you are in the healthcare industry, especially medical coding you must know about social determinants of health (SDOH) which are the conditions in the environment that affect people’s health, life quality and risk of illnesses. The data for social determinants of health refers to the conditions in which people live, learn, play and work. People in medical coding jobs must be aware of and understand the various social determinants of health to capture the SDOH-related Z codes accurately.

To understand better, social determinants of health can be categorized as:

  • Economic stability: The economic status of people determines their capability to afford healthy food, healthcare, and housing. Economic stability comes with steady employment and those with economic stability are likely to be healthy. However, the challenge is with people with disabilities or serious health conditions who are limitedly capable of working affecting their quality of life and capability to spend for their healthcare.
  • Education accessibility: People with access to good education and higher levels of education are likely to be healthier as compared to those with lower levels of education. A person’s financial status, disabilities and experience of social discrimination can affect his/her education thereby impacting the health in the long run due to low-paying jobs and other mental issues.
  • Healthcare access and quality: People who are financially strong or have insurance coverage have access to better quality healthcare. Further, sometimes, access to healthcare depends on the distance of a patient’s place from the healthcare provider’s.
  • Neighborhood and environment: The environment in which people live and grow up has a big impact on their health. Access to safe air and water and harmonious neighborhoods can improve health and quality of life.
  • Social and community context: The kind of relationships and interactions people have with their family, friends, coworkers and community members affects their health.

To provide good and quality healthcare, it is essential to understand these socio-economic factors of patients’ lives that are beyond the healthcare system and with the access and use of social determinants of health data. Medical coding professionals must know this information because they have to use Z codes, a special group of codes in ICD-10-CM codes, to report the factors that influence health status and contact with health services.

What are Z codes?

Professionals working in medical coding companies should be well-versed with Z codes which are diagnosis codes applied for situations where the patients are not diagnosed with a known disorder. These codes (Z00-Z99) represent the reasons for encounters and must be accompanied by a corresponding procedure code wherever a procedure is performed. Medical coders and other professionals in medical coding such as team managers must follow the ICD-10-CM coding guidelines and accordingly assign the corresponding codes to various encounters and review the codes for quality and consistency. Here are some Z codes that need to be well-understood by the medical coders.

  • Z55 relates to problems associated with education and literacy
  • Z56 relates to problems associated with employment and unemployment
  • Z57 relates to occupational exposure risk factors
  • Z59 relates to problems associated with housing and economic circumstances
  • Z60 is about problems related to the social environment
  • Z62 is about upbringing issues
  • Z63 is related to problems associated with family circumstances and primary group
  • Z64 and Z65 are about problems associated with psychosocial circumstances

Social determinants of health play a critical role in healthcare delivery and hence, it is essential that the medical coding fraternity understands this role and accordingly assigns accurate SDOH Z codes on the basis of self-reported data and or information documented in an individual’s health records.

Social Determinants of Health and Medical Coding
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