New Z codes also aimed at reducing hospital readmissions.
The one thing that medicine does not have enough of is abbreviations. So allow me to introduce the RACmonitor audience to another one: SDoH. I am sure many of you are aware of the social determinants of health (SdoH), but for those who aren’t, these are the non-medical factors that affect a person’s health. I don’t think anyone would disagree that a patient with multiple medical problems who is supposed to be taking six medications, including insulin injections, is going to face many more challenges if they are also homeless. Their homelessness is a significant social determinant that has profound effects on their health. So why did I talk about this on Monitor Monday? Shouldn’t it be a topic for Social Worker Saturday?
Well, because SDoH affect a hospital’s readmission rate, length of stay, cost per episode of care, use of post-acute care, and so on. Just recently the Centers for Medicare & Medicaid Services (CMS) has started making an adjustment in the hospital readmission reduction program to account for the percent of a hospital’s patients who are dual eligible—that is, they have Medicare and Medicaid. But other than that, there are no adjustments made for any other social factors, despite their tremendous influence on patient care processes and outcomes.
But there is a groundswell of interest in SDoH, so researchers are looking at data and payers are considering the effects these factors have on patients. In fact, you may have heard that CMS is going to allow Medicare Advantage plans to start addressing their patient’s social determinants by offering non-medical services such as supplying groceries, paying for air conditioning, providing transportation to appointments, and so on.
So as SDoH start to play a bigger role in a hospital’s reimbursement, the only way that the hospital’s data can be adjusted for these social determinants is if the appropriate ICD-10 code is on the claim. So why was I talking about ICD-10 coding on Monitor Monday and not Talk Ten Tuesday? Because a diagnosis can only be coded if it is documented. And that’s where the readers of RACmonitor all come in.
In February, the coding rules were changed by the American Hospital Association so that documentation of SDoH by any caregiver, including case managers and social workers, can now be used to assign a code and report it on the claim. There are actually 88 assignable ICD10 codes in the Z55 to Z65 range, including codes like homelessness, low income, stressful work environment, low literacy, divorce, personal history of abuse, and many more. There is even a code for the millennials: Z62.1- parental overprotection.
I doubt all 88 codes will be used for risk adjustment, but we won’t know which will be used, so we should document and code all applicable conditions. And the more a code is used, the more the researchers will realize it is a factor for them to consider.
We have the codes. We have permission to use the codes. Now it’s up to you to start documenting and asking your coding colleagues to start reporting. You’ll be hearing more about this in the coming weeks from one of my favorite social workers, Ellen Fink-Samnick, on Talk Ten Tuesdays, June 5, 2018, 10-10:30 a.m.
Program Note
Listen to Dr. Hirsch every Monday on Monitor Mondays, 10-10:30 a.m. EST.
Let’s admit it: the International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM) official conventions, guidelines, and advice involving sepsis and its consequences have been
The Centers for Medicare & Medicaid Services (CMS) is continuing its multi-year push toward payment accuracy, documentation integrity, and value-based care. While the most visible
Please log in to your account to comment on this article.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Celebrate Lab Week with MedLearn! Sign up to win one year of our Laboratory All Access Pass! Click here to learn more →
Have a Medicare regulation question you’d love Dr. Hirsch to answer? Now is your chance! CLICK HERE to learn more→
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
