Social Connection Service Requests
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http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1247.95Copied!
Version20240604Copied!
PublisherThe Gravity Project StewardDate2024-06-04T01:21:19-04:00DescriptionAlthough values in the value sets for Procedure and ServiceRequest may initially be identical, they are anticipated to diverge over time. For this reason, there are separate value sets for Procedure and ServiceRequest.
Purpose(Clinical Focus: This set of values represent interventions for Social Connection as selected by the Gravity Project.),(Data Element Scope: In the FHIR ServiceRequest resource, these values may be used for ServiceRequest.code (e.g., for the SDOHCC ServiceRequest profile in the Gravity SDOH Clinical Care FHIR Implementation Guide).),(Inclusion Criteria: Includes SNOMED CT, CPT, and HCPCS interventions for Social Connection as selected by the Gravity Project.),(Exclusion Criteria: NA)
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"display" : "Principal illness navigation services by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator; 60 minutes per calendar month, in the following activities: person-centered assessment, performed to better understand the individual context of the serious, high-risk condition. ++ conducting a person-centered assessment to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors and including unmet sdoh needs (that are not separately billed). ++ facilitating patient-driven goal setting and establishing an action plan. ++ providing tailored support as needed to accomplish the practitioner's treatment plan. identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services. practitioner, home, and community-based care coordination. ++ coordinating receipt of needed services from healthcare practitioners, providers, and facilities; home- and community-based service providers; and caregiver (if applicable). ++ communication with practitioners, home-, and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address sdoh need(s). health education- helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, preferences, and sdoh need(s), and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services (as needed), in ways that are more likely to promote personalized and effective treatment of their condition. health care access / health system navigation. ++ helping the patient access healthcare, including identifying appropriate practitioners or providers for clinical care, and helping secure appointments with them. ++ providing the patient with information/resources to consider participation in clinical trials or clinical research as applicable. facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals. facilitating and providing social and emotional support to help the patient cope with the condition, sdoh need(s), and adjust daily routines to better meet diagnosis and treatment goals. leverage knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals",
"version" : "2024"
}, {
"system" : "http://www.nlm.nih.gov/research/umls/hcpcs",
"code" : "G0024",
"display" : "Principal illness navigation services, additional 30 minutes per calendar month (list separately in addition to g0023)",
"version" : "2024"
}, {
"system" : "http://www.nlm.nih.gov/research/umls/hcpcs",
"code" : "G0136",
"display" : "Administration of a standardized, evidence-based social determinants of health risk assessment tool, 5-15 minutes",
"version" : "2024"
}, {
"system" : "http://www.nlm.nih.gov/research/umls/hcpcs",
"code" : "G0511",
"display" : "Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month",
"version" : "2024"
} ],
"total" : 81,
"identifier" : "urn:uuid:5dd57fea-4816-412e-bc8f-c09ce2b12f45",
"timestamp" : "2024-06-14T15:00:32-04:00"
},
"title" : "Social Connection Service Requests",
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"version" : "20240604"
}