Social Determinants of Health and How It Impacts the EM Level of Service

Format: Live Webinar

Presenter: Diana Brown, BS, CPC, CPMA, CCA 

Event Date: TBD

Time: 1 pm ET | 12 pm CT | 11 am MT | 10 am PT

Duration: 60 minutes

Course Description:

We will review coding guidelines for Social Determinants of Health (SDoH) and how it affects the E/M Level of Service. According to the CDC SDoH are the conditions in the places where people live, learn and work and how these conditions can affect a wide range of health risks and outcomes. Poverty limits access to healthy food and safer neighborhoods and limits the level of quality of education available. Some examples of SDoH are the patient’s level of education, economic stability, safe housing, transportation, environments where people are born, live, learn, work, play, worship, and age that affects a wide range of health, functioning, and quality-of-life outcomes and risks.

When changes to the outpatient and office-visit E/M guidelines took place back in 1/1/2021 the new coding guidelines incorporated SDoH information as part of the complexity level or duration of the E/M visit. Although it is not the most popular topic in medical coding, it is latest and important component in medical coding and documentation that is easily missed, not only in the care of the patient but also in the documentation and the diagnosis codes on the claims.

As insurance carriers begin to recognize the impact of social determinants on the health of patients, it will be important to understand how to identify them in your patient population, how to document them and how to incorporate them into your billing. 

 Learning Objectives:

• Provide awareness and knowledge of SDoH definitions and criteria.
• Provide awareness and ideas for how to identify SDoH in your patient population.
• Learn about the numerous ICD-10-CM codes available for reporting of SDoH.
• Provide an understanding of the way that SDoH is incorporated into the new E/M codes.
• Understanding SDoH and documentation of the complexity of the patient condition as a result will be important to Evaluation and Management code selection for Office and Other Outpatient services.
• Maximize providers’ reimbursement by ensuring SDoH is properly captured in the documentation.    

Areas Covered in the Session:

• Insurance Claims
• Definitions and Criteria
• Patient Population
• Effect on E/M Coding
• ICD-10-CM Coding
• Live Q&A session

Suggested Attendees:

• Healthcare administrators
• Office managers
• Billers and coders
• Auditors and educators
• Practice administrators
• Healthcare providers 
• Physicians
• Non-physician practitioners
• LCSWs
• Clinical support staff
• Revenue cycle directors     

About the Presenter:

Diana has been in the healthcare industry for over 16 years. She has exceptional knowledge and experience in medical billing and coding with a Bachelor's degree in Health Information Management from Charter Oak State College graduating with honors and certifications from the American Association of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA). Skilled in CPT-4, ICD-10-CM, HCPCS coding, chart audits, reimbursement methodologies (in-network and out-of-network) and insurance appeals Diana’s primary focus is to maximize providers’ reimbursement while ensuring documentation compliance.

Diana joined Hackensack Meridian Health Medical Group back in April 2020. As a Coding Education and Audit Manager, she has been in charge of developing and delivering coding education in allegiance with CMS and federal regulation standards. Among the biggest challenges that Diana had to overcome were the transition to Telehealth services during the PHE and the 2021 E/M Guideline changes where Diana along with her team worked tirelessly to ensure services were captured and documented appropriately to conform to these changes.