Social risk contributes significantly to poor health.
These social risks—also known as social determinants of health—include food insecurity, housing instability, transportation insecurity, financial strain, and more.
But without the right terminology about social risk, doctors and other healthcare workers may struggle to identify, support, and report patient’s social needs, which can harm health and hinder research. This is particularly problematic for Latinos and others who are overburdened by social risks.
This why the Gravity Project, a coalition of experts on social risk, is recommending code changes and updates to CDC National Center for Health Statistics’ International Classification of Diseases-Clinical Modification, Tenth Revision (ICD-10-CM), which provides a common language for monitoring and reporting disease, and is the basis of health insurance billing.
You can support the Gravity Project’s social risk proposal for the ICD-10-CM by March 10, 2021:
Our Salud America! team created this quick email with support from the Gravity Project to help you share your support for improving social risk terminology in the CDC’s ICD-10-CM:
I agree with the many health experts who know that social risk (also called the social determinants of health) contribute significantly to a person’s and a population’s health status.
But limitations in existing clinical terminologies complicate our ability to define the needs of patients, share care with social support organizations, represent social risk in insurance claims, measure quality, and report and share disease data. This is particularly problematic for Latinos and other minority or low-income populations, and other minorities who are overburdened by social risks and health disparities.
This is why I support the Gravity Project’s proposal for code changes and terminology updates to CDC’s International Classification of Diseases, Clinical Modification, Tenth Revision (ICD-10-CM). These changes, based on years of peer-reviewed literature and input from social and medical experts, make key recommendations in: housing instability; transportation insecurity; education status; food insecurity; financial strain; veteran status; socioeconomic risk counseling; inadequate drinking water supply; and financial hardship.
Social risk deserves high priority in the ICD-10-CM. I believe the Gravity Project proposal achieves this.
Explore the Gravity Project’s Social Risk Proposal for ICD-10-CM
ICD-10-CM is important because it is a system used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with health care in the United States. It provides a level of detail that is necessary for diagnostic specificity and morbidity classification in the U.S.
Code revisions and updates are normal and necessary to keep up with scientific discoveries.
In December 2020, the Gravity Project and several other organizations developed and submitted proposal to CDC for ICD-10-CM code changes and additions.
On March 9-10, 2021, the CDC’s ICD-10-CM Coordination and Maintenance Committee will hear proposals.
The Gravity Project’s ICD-10-CM recommendations reflect the core domains of the social determinants of health. They are based on years of collaboration with subject matter experts and key stakeholders across the medical and social care community
The Gravity Project and its partners have taken care to recommend revisions that span all applicable coding systems: ICD-10-CM, SNOMED CT, LOINC, and CPTÒ/HCPCS; that are aligned with standardized screening questions and answers such as PRAPARE, the Accountable Health Screening Tool, or the Health Leads Screening Tools; and that are easily operationalized.
The proposed codes across the following domains:
- Housing Instability: there is a vast literature representing the health risks of economically driven housing instability for individuals and families. Yet, there are no specific codes to define this broad risk nor the specific risk of subtypes of housing instability that segue into homelessness.
- Transportation Insecurity: this domain represents both health risks and management complexities as systems consider transportation barriers to care.
- Education Status (Less than a high school degree): although current ICD-10-CM contains general concepts of literacy and underachievement there is, at present no way to distinctly represent the known risk imparted by inability to attain a high school diploma or equivalent, independent of literacy.
- Food Insecurity: the health risks and health costs associated with food insecurity are vast. Furthermore, as evidenced by the research of the USDA, risk increases as severity of food insecurity increases. Yet, there is no specific code for food insecurity.
- Financial Strain and Material Hardship: there is a need for a general concept for financial insecurity and material hardship as the health risks and management needs of each are clear in the peer-reviewed literature and excluded from the individual domains such as food insecurity, housing instability, or transportation insecurity.
- Veteran Status: there is no ICD-10-CM code to represent 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 for a specific counseling code to represent the effort of assessing and patient centered goal setting required to address socioeconomic risks.
- Inadequate Drinking Water Supply: by suggesting a necessary split of Z59.4, the Gravity Project recommends adding Z58 to ICD-10-CM in order to be the base for inadequate drinking water supply and future neighborhood and environment domains.
- Non-compliance and Financial Hardship: based on existing Z91.120 Patient’s intentional underdosing of medication regimen due to financial hardship, it is recommend correlating codes within the “dietary” and “other medication treatment and regimen” roots.
Send Targeted Email to CDC to Support the Gravity Project’s Social Risk Proposal for ICD-10-CM
In addition to our quick email, our Salud America! team created this targeted model email that can help health care professional go more deeply in their support for adding social risk into codes and terminology in the CDC’s ICD-10-CM.
You can copy, edit, and send the following model email to [email protected] by March 10:
Subject: Support for the Gravity Project Social Determinants of Health ICD-10-CM Proposal
Dear ICD-10-CM Coordination and Maintenance Committee,
[I/We/Org name] am writing to offer support for the Gravity Project Multi Domain Social Determinants of Health ICD-10-CM Application.
[Insert personal statement or general statement on SDOH and SDOH data]
Experts have long known that social and environmental determinants of health contribute significantly to a person’s and a population’s health status. However, limitations in existing clinical terminologies and vocabularies complicate our ability to define the needs of patients, share care with social agencies and community organizations, represent social risk in claims, and measure quality.
This is particularly problematic for Latinos, low-income populations, and other minorities who are disproportionately burdened by social risks and disparities in numerous health outcomes.
The Gravity Project’s submission reflects the core domains of the social determinants of health and are based on years of collaboration with subject matter experts and key stakeholders across the medical and social care community.
The Gravity community has carefully considered the degree of risk associated with each domain and its subdomains as presented in the peer reviewed literature.
The rationale for each code suggestion is clearly detailed in the attached submission. As experts in [insert field of expertise here], we would like to highlight a use case for the proposed codes from our own experience. [Insert an anecdote regarding use for one of the suggestions i.e. “transportation insecurity,” “food insecurity,” “housing instability,” etc. For example, nationwide, a higher percentage of Latinos (56.9%) than whites (46.8%) are housing cost burdened, according to a Salud America! Research Review. Additionally, numerous households are spending more than 22% of their annual income on transportation in counties across the country. For example:
- 62% of households in Miami-Dade County, Florida (69.1% Latino) spend more than 22% of their annual income on transportation
- 72% in Maricopa County, Arizona (31.4% Latino)
- 75% in Bexar County, Texas (60.7% Latino)
- 68% in Tulare County, California (65.2% Latino)
These families have less expendable income for healthy food, child care, preventative health care, higher education, professional development, and more.
Additionally, for a trip that takes 20 minutes by car, some people report leaving up to two hours early to be sure they arrive to work on time due to inadequate transit.
However, there are no codes to represent when patients are unable to follow a prescribed regimen because of inaccessible, inadequate, unaffordable, unreliable, or unsafe transportation.]
It is also important to call out the Gravity Project’s request to return the section of the Z58 “Problems related to physical environment” category. The return of Z58 is critical for representation and addressing these social risks with care.
I support the Gravity Project’s proposal and ask for them to be included in the official public comment period.
Thank you for the opportunity to provide these comments for consideration of the Gravity Project ICD-10-CM recommended codes changes, and addition of new codes.
Take Action by March 10, 2021!
If the Gravity Project’s proposed codes are accepted by the CDC’s ICD-10-CM Coordination and Maintenance Committee on March 9-10, 2021, they will be included in a Notice of Proposed Rulemaking to be published in the Federal Register and open for public comment in April.
That’s why we need to ensure that the ICD-10-CM Coordination and Maintenance Committee accepts the Gravity Project’s social risk proposal.
Copy, edit, and send the in-depth model email to [email protected] by March 10, 2021.
Or send the quick email:
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