Study illustrates challenges of billing and coding for social determinants of health

A recent research paper authored by Joy H. Lewis, DO, PhD, examines how health care professionals at community health centers identify and intervene in patients’ social determinants of health—factors such as education, housing, transportation access and wealth that can have a powerful influence on health.

Dr. Lewis is a professor at the A.T. Still University—School of Osteopathic Medicine in Arizona in Mesa. The study involved three Federally Qualified Health Centers which are located in central California, Chicago and New York City. In the study, health care professionals at each center documented social determinants of health for all the patients they saw on a given day of the week, with the study lasting four weeks. A total of 747 cards were completed; on average, each patient was found to have 2.12 social factors that were potentially negatively affecting their health.

The study found that health care professionals were readily able to spot social determinants of health. For nearly one-third of the factors identified, patients were provided with guidance to address them. However, clinicians billed for just 1.2% of the factors they addressed and provided a diagnosis code for less than 7% of factors. These results illustrate the difficulty of billing and coding for social factors and time spent addressing them, note the study’s authors, who suggest that the codes may not be easy to record in electronic health records systems.

In addition, though ICD-10’s Chapter XXI includes codes Z55-Z65, which address some social issues, there are social determinants of health that lack ICD-10 codes, such as language barriers, immigrant or migrant status, transportation access and insurance status.

The study’s authors urge health care organizations to monitor social factors as well as whether and how they are addressed. To learn more, read the complete study in BMC Family Practice.