Question:

Can you settle this question for our coding team? Are smoking and drinking considered Social Determinants of Health?

Answer:

No.

According to the CDC:

“Social determinants of health (SDOH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” [1]

Angela Comfort defines SDoH in an informative article on ICD10monitor.

“Let’s begin by defining the two key elements of this topic. Social Determinants of Health (SDOH), as established by the World Health Organization, are the conditions in which people are born, grow, live, work, and age. These conditions can greatly influence a person’s health, quality of life, and even their lifespan. They include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care.” [2]

So, while smoking and drinking certainly affect health and health outcomes, these are not considered SDoH.

Look at codes in Z55—Z65, Persons with potential health hazards related to socioeconomic and psychosocial circumstances for the ICD-10 codes that are considered SDoH. There may be SDoH codes in other categories (exposure to second hand smoke, for example) but Z55—Z65 is the starting point.

Additional Resources

• HCC coding: V24 versus V28
• Coding Guide – Risk Adjusted Diagnosis Coding for Medical Practices
• HCC Transition from V24 to V28 | Webinar

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[1] CDC Public Health Professionals Gateway – Social Determinants of Health
Accessed July 19, 2023

[2] ICD10monitor – Understanding the Intersection: SDoH and CMS Star Rating Quality Measures
Accessed July 19, 2023

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