- 2025 code changes: What doctors of optometry need to know
- Introducing the new CMS G2211 code
- Coordination of benefits 3 takeaways for optometric billing practices
- Clearing up modifier confusion
- Payor Downcoding: What Is It and What Should You Do About It
- New noteworthy optometry codes
- Modifier -25: How to use it appropriately and avoid costly penalties
- 3 coding questions cracked
- CPT codes deleted in 2023—do you know what codes may be billed to replace them?
- Why Proper Documentation Is Vital
- Common coding questions answered
- Most asked coding questions: dilation
- What does COVID-19 PHE ending mean for telemedicine
- 2 points to keep in mind when patients decline dilation
- social determinants of health
- Can a doctor of optometry bill Medicare for a comprehensive eye exam and a procedure on the same day
- The future of audio-only reimbursement
- Coding conundrums solved
- 7 takeaways from the 2023 Medicare Physician Fee Schedule Final Rule
- Virtual check-in codes
- What your colleagues are asking about coding
- CMS releases 2023 Medicare PFS proposed rule
- Merit-based Incentive Payment System: What doctors should know
- Ask the coding experts
- Merit-based Incentive Payment System quality measures
- Coding for presbyopia eye drops
- Coding and contact lens safety
- CMS 2022 Medicare PFS decreases conversion factor sets new policy goals
- CMS releases information on Part B claims-based quality measure scoring for 2021
- Updated ICD-10 codes take effect October 1
- If it sounds too good to be true
- New EM codes
- What to do when a coding decision is made incorrectly
- 4 coding changes now in effect
- changes in 2021 to coding and documentation for evaluation and management services.
- AOA HPI provides coding benchmark data
- Appropriate use of modifier 25
- Changes on the horizon for evaluation and management services
- AOA Coding Experts gain AMA CPT appointments
- 2020 PFS changes for optometry
- 2020 updates to the ICD-10 code set
- Medicares virtual check-in codes
- The importance of accurate coding and contact lens safety
- coding for cognitive development test
- Medicare evaluation and management documentation and billing
- Coding and audits
- 5 coding queries cracked
- appropriate diagnosis code reporting
- Diagnostic code changes
- 4 coding conundrums clarified
- Where coding and coverage intersect
- Changes on the horizon for evaluation and management documentation and reimbursement
- Global period data collection and possible future changes
- New ICD-10 codes effective
- July-Aug17_Coding Q&As
- The ICD 10 code development process
- coding experts-billing for post-cataract glasses
- accurate coding for public health
- July Aug 2017 Coding Experts
- September Coding Experts
- CMS data collection on postoperative visits
- 3 solutions to common coding problems
- 3 coding changes doctors need to know
- Coding cases cracked
- New diabetes related diagnosis codes
- Get answers to your coding questions
- New ICD10 codes doctors need to know
- Be aware of changes for 2017 and beyond
- Common coding Qs answered
- Coverage indications limitations and medical necessity
- 4 tips for competing with online retailers
- Coding questions cracked
- Access online coding resource for AOA members
- What is the future of CPT coding
- CMS makes changes in how doctors revalidate Medicare enrollment information
- 5 coding changes and clarifications doctors need to know
- More ICD 10 coding Q&As
- Doctors of optometry could see a rise in labor costs under new federal overtime rule
- 4 tips for growing your practice
- HHS unveils proposed rule for new Quality Payment Program
- Ask the Coding Experts Comparative billing reports raise questions on glaucoma patient treatment and coding
- Ask the Coding Experts Modifier 24 and 25 usage
- ICD-10 coding QandAs October
- Ask the Coding Experts Chronic care management services
- ICD 10 transition So far so good
- CMS comparative billing reports What you need to know
- Ready resources for the ICD 10 rollout
- Coding Q&As
- Online payment option makes cents
- Modifiers for distinct procedural services
- Get a refresher on your public Open Payments data
- Final countdown Get answers to your ICD-10 coding questions
- AOA clarifies meaningful use rule on electronic order entry
- More ICD 10 coding QandAs
- Vision therapy coding
- Medicare claims and requests for additional documentation
- Coding QnAs May
- Referring ordering and form 8550
- Reporting code 92250
- One-year Medicare payment fix extends ICD-10 deadline
How and when to code for social determinants of health
May 17, 2023
There can be barriers to the use of Z codes.
Social Determinants of Health Screening Tool
The AOA volunteer doctors developed a downloadable screening tool to help practices assess the health-related social needs of patients. Similar to other clinical assessment tools, the results of a screening tool can be used by doctors of optometry to inform patients’ treatment plans and make referrals to community services. The questions are meant to be used for individual respondents who answer the questions themselves. Alternatively, a parent or caregiver can answer the questions on behalf of an individual.
Written by the AOA’s Coding & Reimbursement Committee. Excerpted from page 46 of the March/April 2023 edition of AOA Focus.
At the beginning of the 21st century, the idea that a patient’s environment has a significant influence over their health was a fledgling concept. It was not until the 2010s that “social determinants of health” (SDOH) was granted more than just a cursory mention in medical texts.
Research on the impact of SDOH began to catch up, and more physicians began to realize that their patients would be more likely to experience better health care outcomes and lower health care costs if their physician incorporated a better understanding of their social environs in their treatment.
Coding mechanisms also had to catch up, however.
Created in 2015, ICD-10 Z codes represent subsets of diagnosis codes describing factors influencing health status. Code categories Z55-Z65 identify SDOH. These codes allow physicians, hospitals, health systems and payers to better track patient needs and identify solutions to improve the health of communities. The Centers for Disease Control and Prevention expanded the list of Z codes in 2021 by creating more specific codes for homelessness and housing instability, and by creating new codes for food insecurity and inadequate drinking water.
There can be barriers to the use of Z codes, which might include a lack of understanding on who can document patients’ social needs, a lack of office systems and processes for documenting and coding social needs, unfamiliarity with SDOH-related Z codes and a low priority placed on the collection of this data previously. For 2023, the ICD-10-CM codes for the social determinants of health were revised and expanded (see pages 103-104 of ICD-10-CM Official Guidelines for Coding and Reporting FY 2023). Codes describing problems or risk factors related to SDOH should be assigned when this information is documented. Providers can assign as many SDOH codes as are necessary to describe all the problems or risk factors when chart documentation indicates that these factors are associated with patient problems and/or risk factors. For example, not every individual living alone would be assigned code Z60.2 (problems related to living alone). But a patient who is not taking their glaucoma medication due to lack of permanent housing or because they could not afford the copay for the medication should be assigned the appropriate SDOH code (i.e., Z59.0 homelessness or Z59.6 low income).
Additional barriers include the limited number of Z codes, the limited or lack of training regarding Z codes, and physicians feeling limited in what they can do and/or how to provide guidance in assisting patients once nonmedical needs have been identified. The notation of adverse SDOH in the clinical record also can raise the level of complexity of care for some patients, leading to a higher level of medical decision making (MDM) and reportable evaluation and management (E/M) service. The 2021 CPT® E/M guidelines for Office and Other Outpatient E/M Services (99202-99215) now includes SDOH in the MDM scoring process for 99204/99214.
With these barriers in mind, what should doctors of optometry do to gain a better understanding of how and when to code for SDOH?
- Doctors of optometry should read and follow the ICD-10-CM Official Guidelines for Coding and Reporting FY 2023.
- Doctors should train themselves and their staff members on the Department of Health and Human Service Using Z Codes: The Social Determinants of Health, Data Journey to Better Outcomes. It is a regularly updated, step-based guide that is easy to read, illustrative and provides links for questions regarding coding for SDOH.
- Doctors of optometry and their staff members should be trained in the collection and reporting of SDOH-related data. The AOA has developed a screening tool to help practices assess the health-related social needs of patients. Upcoming EyeLearn and Optometry’s Meeting® courses will provide further information on best practices.
- Doctors of optometry should put systems into place to connect their patients with the appropriate services to address their unmet social needs.
For any additional questions related to coding for SDOH, doctors of optometry should email the AOA’s Coding Experts.