Social Determinants of Health (SDOH)

In 2021, Social Determinants of Health (SDOH) were added as risk factors to the CPT table used to determine the level of medical decision-making for evaluation and management (E/M) services provided during visits in an office or other outpatient settings. As of Jan. 1, 2023, the same table was added for E/M services delivered in other settings, including inpatient, observation care, emergency departments, nursing facilities, and at a patient’s home or residence. Remember, not only the provider’s documentation is valid for the capture of SDOH codes. Often nurses, social workers, or case managers document this information on a patient’s record.

This link provides a great resource from CMS in regard to the use of SDOH codes: https://www.cms.gov/files/document/zcodes-infographic.pdf

What are SDOH?

According to Healthy People 2030, social determinants of health (SDOH) are the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

SDOH can be grouped into five domains:

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