Up Your Coding Game to Better Leverage SDOH

Healthcare organizations can assure the availability, integrity, security, and usability of SDOH data through data governance, says AHIMA.

Applying data governance strategies can help healthcare facilities capture and use social determinants of health (SDOH) data, and a key part of that process is appropriate coding, according to an American Health Information Management Association (AHIMA) white paper.

"When it comes to revenue cycle, I think what it comes down to is quality," Julie A. Pursley, MSHI, RHIA, CHDA, FAHIMA, AHIMA's director of health information thought leadership and white paper co-author, tells HealthLeaders. "We still want to focus on quality documentation, and quality documentation leads to better coding and just better data overall."

The white paper, "Social Determinants of Health: Improving Capture and Use by Applying Data Governance Strategies," identifies opportunities and challenges for organizations that want to go beyond simply collecting SDOH data and instead use it to affect change. It details how healthcare organizations can assure the availability, integrity, security, and usability of SDOH data.

Data governance, SDOH, and the data lifecycle

Data governance and the data lifecycle are two important factors to consider when it comes to collecting and using SDOH data, and appropriate documentation and coding factor into both.

According to AHIMA, data governance is "the set of policies and procedures that determine the who, how, and why of data management within the organization."

The data lifecycle refers to how data is captured, processed, used, stored, and eventually destroyed.

These are key elements for using SDOH data, but a 2020 AHIMA member survey showed that most organizations did not have a formal governance committee structure to address SDOH data collection and usage.

While that's not surprising considering its newness, it also signals an opportunity for healthcare organizations to start on the ground floor.

"We're at a place now where we can have a big impact in how it's being collected, where it's being collected, and how the data lifecycle is going to act," Pursley says. "We have this great opportunity to really bring in this data in a meaningful way so that it flows correctly and makes it to the proper places for proper healthcare."

Coding success

Improving SDOH coding is a key part of improving data collection.

Organizations can capture data on the "social needs of their patient population using ICD-10-CM codes included in categories Z55-Z65 ('Z codes'), which identify non-medical factors that may influence a patient’s health status," according to the American Hospital Association.

However, there are significant challenges in this area. The AHIMA 2020 survey showed that 27% of respondents found "coding productivity standards are a key challenge in collecting SDOH data," the whitepaper says.

One issue, Pursley notes, comes when coders aren’t sure where in the patient record to find SDOH information.

"Although we are working on getting data collected in a structured manner, a lot of the SDOH data today is peppered throughout [places like] histories and physicals, and social work notes," she says. "Social work notes may not be a place where the coder typically goes to get that information. So, it's all about reengineering this process."

Rather than trying to tackle all the SDOH data in the record at once, revenue cycles and coders can instead "start in a place where you know that you can have a big impact," Pursley says, such as patients with the highest costs or highest chronic conditions that account for a large part of readmissions.

Recommendations for coders

The white paper offers several specific coding-related recommendations for SDOH, including:

• Determining which ICD-10-CM SDOH Z codes will be captured.
   
• Developing internal coding guidelines to identify categories of clinicians for whom documentation can be used for accurate code assignment and note the location of this information in the health record.
   
• Updating computer-assisted coding (CAC) systems and other clinical documentation tools to capture structured and unstructured data.
   
• Defining various SDOH document types and sources from which data needs to be pulled to enhance automation, enabling the CAC system to present information sets in various work queues to the health information professional.
   
• Providing coding professionals with training that's consistent with the American Hospital Association's Coding Clinic guidance and the use of SDOH Z codes.
   
• Determining the location of where certain SDOH document types will be stored and in which information systems they can be retrieved.
   
• Ensuring SDOH codes are not pulled forward without proper validation. Life circumstances such as homelessness and unemployment often change, and documentation must be updated to reflect the current encounter.

These coding-specific recommendations and others drive home the importance of teamwork, both within the healthcare organization and with community-based organizations to achieve "whole-person care."

"My advice for revenue cycle leaders would be … don't work in a vacuum," Pursley says. "This is a big issue. You should be collaborating with a variety of leaders, internally and externally."