Part of the new assessment items in the OASIS-E are the Social Determinants of Health (SDoH). SDoH describe environmental and socioeconomic conditions that affect a wide range of health functioning, quality-of-life outcomes, and risks, including but not limited to the ability to access healthy food, live in a safe environment, visit a health provider, and understand instructions pertaining to their health and well-being, among other factors.
The Vital Role of Clinicians in Documenting SDoH
The recent focus on diversity, equity, and inclusion has further emphasized the importance of SDoH, helping clinicians and payers understand how socioeconomic factors impact patient outcomes. Now, more than ever, home care is uniquely positioned to collect this data through clinicians using the new OASIS-E.
The following are components of SDoH:
- Ethnicity (specifically asking about Hispanic, Latino/a, or Spanish origin)
- Race
- Preferred language (including need or want of an interpreter)
- Transportation
- Health literacy
- Social isolation
Including the SDOH items in the OASIS-E makes it possible for the aforementioned components that affect patients’ health to be given the proper attention. Since home health clinicians see patients within the personal context of their homes, clinicians can identify living conditions and social support or the lack thereof. Equipped with this information, providers can be more effective in providing care for underserved populations and addressing these SDoH factors to improve outcomes.
Documenting SDoH in the OASIS
Since the SDoH criteria are a new addition to OASIS, clinicians’ and coders’ education is the first step toward better understanding the overall health status of patients as influenced by SDoH. By understanding and accurately documenting SDoH for analysis throughout the care episode, clinicians and coders can work hand-in-hand to further improve patient care and outcomes.
Here are a few guidelines for documenting SDoH in the new OASIS-E:
- It is now required to record data describing SDoH in the OASIS whenever this information is described by a patient or clinician.
- SDoH responses in the OASIS may be based on a clinician’s report who is not the patient’s attending provider since this information represents social information rather than a medical diagnosis.
- SDoH can be patient-reported if the information is authenticated by a clinician or physician.
Assigning Z Codes for SDoH
Below are the SDoH codes and their meanings:
The code I.C.21.c.17 describes problems or risk factors related to SDoH, which should be assigned when SDoH is documented. Make sure to assign as many SDoH codes as necessary to describe all the problems or risk factors. Only assign codes when the documentation specifies that the patient has an associated problem or risk factor.
On the other hand, individual categories Z55-Z65 describe specific conditions. Coders should become familiar with these parent categories along with the subcategories, which describe each specific situation.
- Z55 Problems related to education and literacy
- Z56 Problems related to employment and unemployment
- Z57 Occupational exposure to risk factors
- Z58 Problems related to physical environment
- Z59 Problems related to housing and economic circumstances
- Z60 Problems related to social environment
- Z62 Problems related to upbringing
- Z63 Other problems related to primary support group
- Z64 Problems related to certain psychosocial circumstances
- Z65 Problems related to other psychosocial circumstances
Proper Documentation Leads to Better Care
Documenting the patient’s needs is a shared duty between clinicians and coders with proper education and accurate recording of validated SDoH components. Accuracy in assessing SDoH plays a vital role in identifying the right interventions and creating an effective plan of care that addresses the patient’s specific needs. This will contribute to a positive impact on the individual’s health, and overall well-being.
With this huge responsibility at hand, make sure your coding team/provider is knowledgeable of the codes that represent these defined needs and how to use them appropriately. With proper training and education, coders should be able to thoroughly analyze and accurately interpret the context as they are coding.
