Video Transcript: Z Codes: Information for Administrators
Screening and coding for social determinants of health is challenging.
But there are solutions that can help.
Let’s go through some challenges and possible solutions.
Screening for social determinants of health takes time.
Consider partnering with different areas of your hospital or facility to gather information. With a team approach, you can use patient self-reported information and electronic health record (or EHR) screening tools to help build initiatives. Some EHR systems have modules that reduce the time it takes to code social determinants of health.
Your EHR system may already have access to these features. If so, ask your EHR vendor to turn these features on and schedule a training for your staff.
Providers might worry that patients will see these screening questions as intrusive and not want to ask them.
Studies show that many patients welcome these questions.
In general, research shows that patients:
- Believe screening for social risks is important
- Understand connections between social risks and overall health
- And accept the importance of social risk screening
It’s important to ask these questions sensitively. Make sure your providers are trained to express empathy and respect and acknowledge the patient’s autonomy.
You may be worried about liability if you can’t treat all the issues captured in a screening. But many patient issues can be coded without a corresponding intervention.
You only need to respond if the issue falls under your state’s mandatory reporting guidelines.
It may feel challenging for coders at your facility to use Z codes. They may not know the ICD-10-CM Z codes that cover social determinants of health or where to find modules in the EHR.
One solution is to encourage coders at your facility to take this training. Lessons 1 and 2 include general information about Z codes, relevant to coders. There’s also a section of Lesson 3 tailored for coders.
Seeking reimbursement may feel challenging because Z codes aren’t first-listed or principal diagnoses. They also aren’t procedure codes. Many facilities aren’t reimbursed for capturing or coding social determinants of health issues.
Health care is moving toward value-based or alternative payment models that tie payment to quality and efficiency, and as you will see later in this lesson, CMS is making changes to ensure reimbursement for efforts related to social determinants of health. Nearly all Medicare settings use these models, including hospitals and outpatient and post-acute facilities.
One additional challenge is that health care facilities may not have policies about the use of Z codes.
Health care facilities can work with other organizations, consider value-based reimbursement, and create policies with future changes in mind.
Now that we’ve discussed why you should screen for social determinants of health, let’s look at
- How to screen
- Where and when screening occurs
- And how to collect information
The ICD-10-CM Official Guidelines for Coding and Reporting guides users in proper assigning and documenting of Z codes.
The ICD-10-CM guidelines say you can assign as many Z codes as needed to describe a patient’s problems or risk factors.
But you must include complete documentation for all of these codes as well.
The documentation must specify that a patient has an associated problem or risk factor.
For example, code Z60.2 involves problems related to living alone. But you shouldn’t assign code Z60.2 to every patient who lives alone.
Note that anyone involved in the care of a patient who meets the definition of a clinician can document social determinants of health for that patient.
You can assign Z codes based on documentation of a patient’s social information from:
- Social workers
- Community health workers
- Case managers
- Nurses
- Physicians
- And other providers and clinicians
You must maintain and keep all this documentation in the patient’s official medical record.
Your documentation can include patient self-reported information as well as data from any provider, including non-physicians, who work with your patient.
Make sure your documentation is clear and complete so coders can assign all appropriate codes, including Z codes.
A health care facility can capture patients’ social determinants of health information during:
- Emergency department visits
- Unexpected visits for acute issues
- Screenings
- Routine check-ups
- And scheduled appointments
Your health care teams can collect this information at any point in a patient visit, including:
- Enrollment or intake
- Assessment
- Diagnosis
- Treatment
- And discharge
You can get this information from patients:
Verbally with a screening tool used by a provider or patient navigator. Talk to patients in person, over the phone, or even via video conferencing.
Via paper questionnaire: Patients can complete the questionnaire, or a provider can complete it for them based on discussion with the patient
Electronically via:
- Screening tools completed by patients on a kiosk
- Tablet-based electronic portal at intake
- And an online patient portal
Providers also can enter information from a paper questionnaire or from their conversation with the patient.
Remember: Any clinician involved in the care of a patient can gather social determinants of health information, even if they aren’t the patient’s primary provider.
And: You can use a patient’s self-reported information in your EHR documentation.
We recommend carefully reviewing the ICD-10-CM Official Guidelines for Coding and Reporting before working with Z codes.
You can find links in the Reference tab to the research, guidelines, and studies discussed in this video.