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ICD Social Codes: An Underutilized Resource for Tracking Social Needs

Torres, Jacqueline M. PhD, MPH*; Lawlor, John PhD, MS; Colvin, Jeffrey D. MD, JD; Sills, Marion R. MD, MPH§; Bettenhausen, Jessica L. MD, FAAP; Davidson, Amber RHIT, CCS, CCS-P; Cutler, Gretchen J. PhD, MPH#; Hall, Matt PhD; Gottlieb, Laura M. MD, MPH**

doi: 10.1097/MLR.0000000000000764
Original Article
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SDC

Background: Social determinants of health (SDH) data collected in health care settings could have important applications for clinical decision-making, population health strategies, and the design of performance-based incentives and penalties. One source for cataloging SDH data is the International Statistical Classification of Diseases and Related Health Problems (ICD).

Objective: To explore how SDH are captured with ICD Ninth revision SDH V codes in a national inpatient discharge database.

Materials and Methods: Data come from the 2013 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, a national stratified sample of discharges from 4363 hospitals from 44 US states. We estimate the rate of ICD-9 SDH V code utilization overall and by patient demographics and payer categories. We additionally estimate the rate of SDH V code utilization for: (a) the 5 most common reasons for hospitalization; and (b) the 5 conditions with the highest rates of SDH V code utilization.

Results: Fewer than 2% of overall discharges in the National Inpatient Sample were assigned an SDH V code. There were statistically significant differences in the rate of overall SDH V code utilization by age categories, race/ethnicity, sex, and payer (all P<0.001). Nevertheless, SDH V codes were assigned to <7% of discharges in any demographic or payer subgroup. SDH V code utilization was highest for major diagnostic categories related to mental health and alcohol/substance use-related discharges.

Conclusions: SDH V codes are infrequently utilized in inpatient settings for discharges other than those related to mental health and alcohol/substance use. Utilization incentives will likely need to be developed to realize the potential benefits of cataloging SDH information.

Supplemental Digital Content is available in the text.

*Center for Health & Community, UC San Francisco, San Francisco, CA

Children’s Hospital Association, Washington, DC

Department of Pediatrics, University of Missouri–Kansas City School of Medicine, Kansas City, MO

§Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO

University of Missouri, Pediatric Hospital Medicine Fellowship Children’s Mercy Hospital, Kansas City, MO

Children’s Hospital Association, Overland Park, Kansas, Lenexa, KS

#Department of Pediatric Emergency Medicine, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN

**Department of Family and Community Medicine, University of California at San Francisco, San Francisco, CA

The authors declare no conflict of interest.

Reprints: Laura M. Gottlieb, MD, MPH, 3333 California Street, Suite 465, San Francisco, CA 94118. E-mail: laura.gottlieb@ucsf.edu.

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