Social Determinants Now Play A Bigger Role In Medical Coding

by  Find-A-Code™
May 11th, 2023

As the 2023 ICD-10-CM updates begin to roll out, medical coders and billers are seeing mostly what they have been led to expect. There have been a few surprises here and there. Right now, the hot topic of the day is how much social determinants now contribute to medical coding. As of April 1, among the 42 new diagnostic codes and 34 procedure codes, many of them are related to social determinants.

A social determinant is a societal factor that influences a patient's health. For example, Health Leaders Media contributor Amanda Norris cites literacy and educational issues as social determinants now encapsulated in ICD-10 codes.

The ICD-10-CM Official Guidelines for Coding and Reporting have been updated to reflect the social determinants codes. For the record, social determinants are being referred to as social determinants of health (SDOH). Familiarize yourself with a new acronym. You are going to see it a lot.

New Codes Are Now Billable

Medical coding and billing specialists might already be familiar with the new SDOH codes given that they were introduced late last year to give coders time to get familiar with them. But the new codes are billable as of April 1. In addition to education and literacy, other social determinants identified within the new set include:

• financial abuse
• maltreatment and neglect
• employment and unemployment
• occupational exposure and risk
• housing and other economic circumstances
• physical and social environments

The new codes are designed to help both clinicians and payers understand how social determinants impact health. The idea is that better understanding allows for better care – both preventative care and care provided after-the-fact. Combining better preventative care with intervention should lead to better outcomes.

What It Means to Coders and Billers

As with every other update to ICD-10, the 2023 update gives both medical coders and billers a new set of codes to familiarize themselves with. Clinicians should also be familiar with them as they are the ones who create the original records coders and billers work from. It's probably going to take some time for things to work smoothly. In the interim, billers and coders will have to do the best they can with the resources they have.

We encourage medical coders to make sure that all their resources are up to date. Whether they get their medical codes online, through printed documents, or any combination of both; accurate codes are paramount to accurate billing. And if you are a medical coder or biller who hasn't yet taken a look at the new codes relating to social determinants, do not put it off any longer. The new codes are here and billable.

ICD-10 Continues to Evolve

This latest update is a reminder that the ICD-10-CM code system continues to evolve. With every update there are both new codes and deletions. There are new entries for both billable and non-billable codes. There are all sorts of changes that require attention. That is one of the reasons we constantly encourage coding and billing specialists to make sure their resources are up to date.

In closing, the industry is already talking about updates in the pipeline for 2024 and 2025. Medical coders and billers can do themselves a favor by staying abreast of any news pertaining to code updates. And remember, ICD-10 represents just one set of codes. There are other code sets designed for other purposes. They are routinely updated as well.

It will be interesting to note if the other code sets give as much attention to social determinants. For now, though, social determinants are playing a vital role in the ICD-10 code set.