Social determinants of health

Question:

I see that the new E/M guidelines for codes 99202—99215 include social determinants of health, as moderate complexity. What is a social determinant of health? Does it include smoking and alcohol use?

Answer:

According to the CDC, social determinants of health “encompasses economic and social conditions that influence the health of people and communities.” It typically includes homelessness, food insecurity, unsafe living conditions (access to clean water, pollution free air), and economic insecurity. One specific example is not having the money to afford medications. It does not include smoking or alcohol use.

I wrote an article for Medscape about coding for these conditions, that you can read here.

The ICD-10 codes are in the last chapter of the code set, and includes categories Z55-Z65: “persons with potential health hazards related to socioeconomic and psychosocial circumstances.” These codes don’t bring increased reimbursement on a claims basis, unfortunately. But they provide information to health plans and Accountable Care Organizations about the factors that affect patient health and outcomes. Health systems may want to track this data, too, as they consider costs and quality, as well as outcomes.

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