Provider Alert! Screening and Coding for Social Determinants of Health

Provider Alert!

Provider Alert! Screening and Coding for Social Determinants of Health

Attention: Primary Care and Obstetric Care Providers

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: As stewards of our member’s care, Texas Children’s Health Plan (TCHP) would like to raise your awareness of social determinants of health.  Social determinants of health (SDOH) are non-clinical societal and environmental conditions such as lack of access to adequate food, housing, transportation and education, along with unsafe environments, inadequate social support, employment and behavioral stability support, which prevent individuals from accessing health care they need.  Research shows that an individual’s socioeconomic and/or psychosocial needs correlate with his or her health and wellness.  Systematically identifying these barriers allows healthcare providers and TCHP to help patients overcome the obstacles.

How this impacts providers: Texas Children’s Health Plan supports routine screening, documentation and submission of the appropriate ICD-10 code(s) for SDOH identified as affecting our members and working together to address our members’ needs.

Many screening tools are available for your use.  An example of a tool that includes multiple simple questions is below:

Standardized SDOH Screening Questions

There are programs to help people with needs that can affect their health, but they aren’t reaching everyone who may need them. Are there things you need help with?

Food

1.       Within the past 12 months, did you worry that your food would run out before you got money to buy more? (Y/N)

2.       Within the past 12 months, did the food you bought just not last and you didn’t have money to get more? (Y/N)

Housing/Utilities

4.       Do you have housing? (Y/N)

5.       Are you worried about losing your housing? (Y/N)

6.       Within the past 12 months, have you or your family members you live with been unable to get utilities (heat, electricity) when it was really needed? (Y/N)

Transportation

7.       Within the past 12 months, has lack of transportation kept you from medical appointments, getting your medicines, non-medical meetings or appointments, work, or from getting things that you need? (Y/N)

Interpersonal Safety

8.       Do you feel physically and emotionally safe where you currently live? (Y/N)

9.       Within the past 12 months, have you been hit, slapped, kicked or otherwise physically hurt by someone? (Y/N)

10.   Within the past 12 months, have you been humiliated or emotionally abused in other ways by your partner or ex-partner? (Y/N)

Optional to Add

11.   Are any of your needs urgent? For example, I don’t have food for tonight, I don’t have a place to sleep tonight, I am afraid I will get hurt if I go home today? (Y/N)

Source: https://files.nc.gov/ncdhhs/documents/SDOH-Screening-Tool_Paper_FINAL_20180405.pdf

Next steps for providers: TCHP recognizes that the list of ICD-10 codes is not comprehensive of all social determinants.  This is a step that TCHP and our provider network can take to improve the health of our members throughout our communities.

A listing of the ICD-10 codes applicable to SDOH can be found at the link below:

https://icd.who.int/browse10/2016/en#/Z55-Z65

When a social determinant of health is recognized, provider offices include the related ICD-10 Code(s) when submitting a claim for a member affected by any of the applicable categories

Coding Information

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Source: https://icd.who.int/browse10/2016/en#/Z55-Z65

Resource:
ICD-10 Coding American Hospital Association

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.

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