Roundtrip advocates for the additions to ICD10-Z Codes to battle SDOH

Vraj Vyas
Vraj Vyas
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With core pillars consisting of access to proper food, housing, transportation, and education, social determinants of health (SDOH) is one of the most relevant topics in healthcare right now, and it very well should be. SDOH correlate with issues that directly affect patients from accessing the care they need when they need it, and these factors are a result of the conditions and circumstances surrounding peoples’ lives — including where they work, live, play, and eat.

What are Z codes?

According to the World Health Organization (WHO) the International Classification of Diseases (ICD) “is the foundation for the identification of health trends and statistics globally, and the international standard for reporting diseases and health conditions.” ICD-10 codes, short for International Statistical Classification of Diseases and Related Health Problems 10th revision, are a part of a medical classification system used for clinical diagnosis and billing in the healthcare industry across the nation. Z codes fall under ICD-10 codes for reporting factors that influence health status and contact with health services.

How can Z codes impact healthcare and the SDOH conversation?

Earlier this year, the American Medical Association (AMA) and United Healthcare partnered to propose about 23 new ICD-10 “Z codes” targeting factors related to social determinants of health. The proposed codes would dive deeper, classifying a patient’s circumstances outside of the hospital. While there are some codes that already focus on patients’ circumstances, they are very generalized. The new codes aim for greater calibration in hopes to standardize data and pinpoint the factors relating to one’s social determinants of health. These codes could be a considerable advancement in understanding the factors causing SDOH, and instrumental in developing potential strategies to battle it.

Patients’ access to proper transportation, which falls under the core of SDOH, is a pain point that Roundtrip is working to solve at hospitals and health systems nationwide. With the new ICD-10 codes, patients who do not have the proper transportation to get to the hospital or pharmacy can be appropriately diagnosed and helped. These codes also have the potential to assist healthcare facilities, institutions, and corporations in determining the immediate need for attention in the space. Specific to transportation, the proposed ICD-10 Z codes that directly correlate with Roundtrip’s mission to improve health outcomes are:

  • Z59.641 Unable to pay for transportation for medical appointments or prescriptions
  • Z59.642 Unable to pay for transportation unrelated to health care – work 
  • Z59.643 Unable to pay for transportation unrelated to health care – getting things needed for daily living

(source: Patchwise Labs)

And some of the ones indirectly correlate are:

  • Z55 Problems related to education and literacy
  • Z56 Problems related to employment and unemployment
  • Z60 Problems related to social environment
  • Z91 Personal risk factors, not elsewhere classified

(source: AHA)

Where does Roundtrip help?

At Roundtrip, our mission is to improve health outcomes by providing the best possible rides for patients through the simplest coordination imaginable, so our goal is to securely leverage the ride data we collect and correlate it to healthier outcomes. Our platform is designed to help healthcare professionals understand and keep track of ride data, and can be used as an invaluable tool to identify patients’ SDOH. And based on our data, we can confirm that there is not only a significant need for rides to medical appointments but there is also a major need for non-medical transportation that contributes to healthier living for populations that face challenges affording it. Ultimately, we can help determine and quantify patient Z codes through our platform.

We recognize that a physician’s primary responsibility is attending to the care of their patients, so collecting and reporting Z codes is not always feasible, and due to the sensitive nature of SDOH, collecting this data directly from the patient faces challenges of its own. This is why we built Roundtrip’s platform — to be easy to use and allow for seamless workflows for physicians and care coordinators alike. Therefore, using Roundtrip to coordinate transportation empowers healthcare professionals to address transportation as a factor of SDOH, and collect data with minimal friction.

One of our flagship partners, The Greater Richmond Transit Company (GRTC), is the primary public transportation provider for Richmond, VA. While much of Roundtrip’s work happens at hospitals and health systems, GRTC was the first city-wide application addressing SDOH with transportation. Currently, GRTC operates 37 local routes and 10 express routes that provide transit service within the City of Richmond, Henrico County, and a portion of Chesterfield County–a service area that accounts for more than 8 million passenger rides yearly. In addition to traditional fixed-route service, GRTC’s CARE services provide origin-to-destination services under the guidelines of the Americans with Disabilities Act (ADA) for the citizens of the Richmond Region. 

Starting in 2017, Roundtrip has delivered over 11,000 rides for paratransit customers through a precedent-setting transportation program with greater flexibility in meeting their mobility needs. Through Roundtrip, “CARE On-Demand” enables paratransit customers the option to utilize a subsidized, same-day, direct, non-stop trip. Roundtrip does hundreds of CARE On-Demand rides each week, and GRTC is now able to automatically log all ride details and collect information about the accessibility of each customer, providing a subsidized service to improve the lives of its customers, and process one invoice for on-demand transportation needs.

At Roundtrip, we understand the importance of SDOH as we provide rides that address SDOH daily. As we continue to explore the complex factors of SDOH, we are driven to deliver more engaged and empowered transportation experiences for our riders. We are doing more than expanding access to care; we are helping people live healthier lifestyles every day. Z codes are the crucial next step in building healthier communities in the U.S. We believe they will serve as an indispensable data resource to help more key people understand how to achieve health equity more perfectly.

Sources

  1. Livingston, S. (2019, April 02). UnitedHealthcare, AMA unveil more medical codes for social determinants. Retrieved from https://www.modernhealthcare.com/technology/unitedhealthcare-ama-unveil-more-medical-codes-social-determinants
  2. /@patchwiselabs. (2019, April 11). At a Glance: New Z-Codes for SDOH – Patchwise Labs. Retrieved from https://medium.com/patchwiselabs/at-a-glance-new-z-codes-for-sdoh-5368f354c769
  3. Davis, E. (2019, June 24). Medical Codes: What Are ICD-10 Codes & How Do They Work? Retrieved from https://www.verywellhealth.com/icd-10-codes-and-how-do-they-work-1738471
  4. American Hospital Association (2018, April). ICD-10-CM Coding for Social Determinants of Health. Retrieved from http://www.ahacentraloffice.org/PDFS/2018PDFS/value-initiative-icd-10-code-sdoh-0418.pdf