The Gravity Project Recommends Social Risk Codes for ICD-10-CM

Proposals were made during recent Coordination and Maintenance Committee.

The healthcare industry has consistently asked when ICD-10-CM codes will better address the social determinants of health (SDoH). With the industry focused on the COVID-19 pandemic over the past year, the ICD-10 code pendulum did not swing in this direction.

Yet data remains compelling; more than half of all readmissions are prompted by the psychosocial factors of housing, food insufficiency, transportation access, isolation, the environment, quality of and access to care, and others. The Gravity Project has been focused on these vital areas.

Comprised of subject matter experts and stakeholders from across the industry, for those not familiar, The Gravity Project was started in late 2018 by the Social Interventions Research and Evaluation Network (SIREN), with funding from the Robert Wood Johnson Foundation. The goal was to convene broad stakeholder groups to identify and harmonize social risk factor data for interoperable electronic health information exchange.

This is the Project’s week to shine! On March 10, Project representatives had the opportunity to present their proposal to recommend ICD-10-CM code changes and updates to the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics’ Coordination and Maintenance Committee. The proposal incorporates social risks across populations, spanning the following areas:

• Housing Instability: Despite vast evidence of the health risks of economically driven housing instability for individuals and families, no specific codes define this broad risk – or specific risk of subtypes of housing instability that can evolve into homelessness.
• Transportation Insecurity: Health risks and management complexities are factors to take into account as providers consider transportation barriers to care.
• Education Status: Current ICD-10-CM codes include general concepts of literacy and underachievement, yet no way exists to distinctly represent known risks of the inability to attain a high school diploma or equivalent, independent of literacy.
• Food Insecurity: Vast health risks and health costs are associated with food insufficiency. The evidence reflects how both risk areas increase with rate and severity of food insecurity. However, no dedicated code exists for among the most frequently occuring SDoHs.
• Financial Strain and Material Hardship: The literature validates need for a code denoting financial insecurity and material hardship, which contribute to health risks and management needs, separate from food insecurity, housing instability, or transportation insecurity.
• Veteran Status: There is no ICD-10-CM code for veteran status. The existing code, Z91.82, personal history of military deployment, is often incorrectly applied; one can be a veteran and never be deployed.
• Socioeconomic Risk Counseling: The need is identified for a specific counseling code that represents assessment and patient-centric goal-setting that addresses socioeconomic risks.
• Inadequate Drinking Water Supply: The Project recommends adding Z58 in order to serve as the base code for inadequate drinking water supply and future neighborhood and environment domains. This effort would involve a necessary split of Z59.4.
• Non-compliance and Financial Hardship: Based on existing code Z91.120, Patient’s intentional underdosing of medication regimen due to financial hardship, the Project recommends correlating codes within the “dietary” and “other medication treatment and regimen” roots.

Further information on The Gravity project’s work can be viewed on their website.

This week’s Monitor Mondays Listeners Survey polled our listeners about the top entries on their ICD-10-CM code wish lists, with powerful responses. This is an evolving story that RACmonitor and ICD10monitor will continue to follow, so watch for important updates.

Programming Note: Listen to Ellen Fink-Samnick’s live reporting on the SDoH every Monday on Monitor Mondays, 10 a.m. Eastern.