Using ICD-10 Z Codes to Identify Social Determinants of Health

The relationship between social determinants of health (SDOH) and improved patient outcomes is a well-established idea¹. And, like so many aspects related to healthcare in the U.S., there’s an ICD-10 code for that.

Specifically, ICD-10 Z Codes² relate to nonmedical factors affecting our patients’ health which can affect rehab therapy journeys.

Z codes Z55 through Z65, for example, are related to social determinants of health. In ICD-10, we see they are described as persons with potential health hazards related to socioeconomic and psychosocial circumstances.

ICD-10 Z Codes Standardize SDOH Documentation

Where and how people live, learn, work and play impacts health outcomes and quality of life³. Collectively, these are known as social determinants of health. We share more about SDOHs in our previous post, “Leverage Social Determinants of Health for Better Patient Engagement, Outcomes in Rehab Therapy.”

As the focus on health equity increases, the Centers for Medicare & Medicaid Services (CMS) is using ICD-10 Z Codes to standardize a way to capture SDOH information⁴.

Once collected, SDOH information will be utilized to establish a baseline set that will hopefully reflect the realities of patients throughout the country. This data will then be available to support and influence public policy and social and community development, ideally for the greater improvement of healthcare equity.

ICD-10 Social Determinants of Health Z Codes Z55-Z65

Digging deeper into codes Z55 through Z65, we see they are related to socioeconomic topics such as education and literacy (Z55), employment (Z56), housing (Z59), upbringing (Z62), and family (Z63).

Codes Z64 and Z65 represent problems related to psychosocial circumstances such as unwanted pregnancy (Z64.0) and exposure to disaster (Z65.5).

Due to the complexity and sensitivity of this information, CMS recommends⁴ choosing a suitable SDOH screening tool. Such tools enable rehab therapy care teams to collect data without increasing staff burden, making it part of the regular patient evaluation process.

Making an initial decision about which Z code data will be most useful to monitor can make the process more succinct for your team. A robust EMR or EHR solution will allow you and your team to seamlessly record data directly within patient records.

ICD-10 Z Code Updates for 2023

Beginning Oct. 1, 2022, updates to Z code Z59.8 have taken effect for the fiscal year 2023. Although there is no change to Z59.8, or “other problems related to housing and economic circumstances,” additional codes have been established to allow for greater specificity.

For example, three new codes depict scenarios that may limit a patient’s ability to schedule, attend and/or pay for their rehab therapy appointments:

• Transportation insecurity (Z59.82) describes issues of inaccessible, inadequate, unaffordable, unsafe and unreliable transportation.
• Financial insecurity (Z59.86) includes bankruptcy, burdensome debt and economic strain.
• The inability to obtain adequate childcare, clothing, utilities and basic needs is covered in material hardship (Z59.87).

Benefits of Collecting SDOH Data

Primarily, SDOH data will be associated with CMS reimbursement in the future. Having a streamlined process, facilitated through your EMR or EHR software, can support a seamless transition.

But also, imagine that patient who you now know has issues with literacy, represented by code Z55.0. Gone is the blank stare as you give them handouts and diligently prepared written care plans.

With a better understanding of this patient’s limitations in reading and comprehension, your rehab therapy team knows to communicate verbally and with greater sensitivity. Not only will this potentially help with patient follow-through on the care plan, but this may also result in better rehab therapy outcomes.

Plus, your team can link the patient to community resources that may help improve their literacy.

Or what about code Z59.811 for housing instability? If a patient has experienced multiple moves that limited their rehab therapy success, your team can refer him or her to community resources that help establish more secure housing and, hopefully over time, more successful therapy outcomes.

And, in the bigger picture, the high use of Z code Z59.811 could incentivize policymakers to establish more effective long-term, affordable housing programs for low-income constituents, resulting in greater levels of health equity in a town, state or region.

Net Health Therapy EHR Solutions Capture SDOH Data

All of our Net Health Therapy EHR solutions – Net Health Therapy for Clinics, Net Health Therapy for Senior Living, and Net Health Therapy for Hospitals (both Acute Care and Outpatient) – make it seamless to record and report via Z codes.

Please check specific payer coverage guidelines related to the use of these ICD-10 codes for rehabilitation services.

Plus, a good selection of standardized measures and tools exist for practitioners who wish to include social determinants of health as part of their initial evaluation process. These tools help you determine the information you need to seek as well as help you record and track this information for your patients.

Learn more about such tools and how to put them to good use throughout your rehab therapy team by watching our free webinar titled, “Leveraging Social Determinants of Health Data to Advance Patient Outcomes.”

If after watching our webinar you still have questions about collecting SDOH data and updating codes throughout your documentation, or you simply wish to learn more about our Net Health Therapy EHR products, contact us today to schedule a free demo!

REFERENCES:
¹ Revcycle Intelligence, How Hospitals, EDs Effectively Code Social Determinants of Health, July 27, 2022
² Centers for Medicare & Medicaid Services, 2023 ICD-10-CM, July 27, 2022
³ Healthy People 2030, Social Determinants of Health, Sept. 30, 2022
⁴ Centers for Medicare & Medicaid Services, Z Codes Infographic – 2022, June 2022