This page addresses follow-up questions and additional information pertinent to our webinar
Social Determinants of Health: What’s the Big Deal?.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.
Q: Are social determinants of health limited to codes Z55-Z65?
A: No. Although most SDOH codes are found in categories Z55-Z65, there are other codes, such as R45.89 for loneliness that could be considered a social determinant of health.
Q: Are there any other SDOH codes proposed for CCs for FY 2025?
A: Yes. For FY 2025, CMS has proposed to add 7 new codes to the CC list for inadequate housing and housing instability.
Q: Are quality measures for SDOH determined based on Z codes?
A: No. Core measures for SDOH are reported to CMS using a web-based data collection tool.
Q: If Z codes aren’t used to report SDOH data for the quality improvement program, then why do we need to be sure our SDOH Z codes get reported on the claim?
A: Medicare and other payers analyze claims data for trends and conditions that impact the cost of healthcare. By reporting SDOH codes in the top 25 diagnoses on facility claims and top 12 diagnoses on provider claims, you can ensure that the payer has data for SDOH codes. This could impact future payment, as we’ve seen with the addition of some SDOH codes as CCs under the inpatient prospective payment system.
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Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer
Director of Coding Quality & Education
Kristi is the Director of Coding Quality & Education with more than 25 years of industry experience; she is responsible for the development of web-based, instructor-led, and webinar training materials; conducting training in ICD-10-CM/PCS and CPT; and performing DRG and APC audits. Kristi has an extensive background in coding education and consulting and is a national speaker and published writer on topics related to ICD-10 and CPT coding and code-based reimbursement. She has designed and developed training programs for inpatient and outpatient hospital-based coding, with a focus on vascular interventional radiology, interventional cardiology, orthopedics, and obstetrics.
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