May 27, 2023 | Net Health

9 min read

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

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 non-medical factors (aka social determinants of health) affecting public health, which can and often does affect rehab therapy journeys.

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

Z Codes Standardize Social Determinant of Health Documentation

SDOH Z Codes are a specialized set of codes within the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). These ICD codes are designed to document the various social and environmental factors that can influence an individual’s health.

For instance, these ICD codes capture data on housing and economic circumstances, education and literacy problems, and psychosocial circumstances. By identifying potential health hazards related to socioeconomic and psychosocial circumstances and factors influencing health status, SDOH Z Codes play a crucial role in tracking and addressing health disparities. This comprehensive documentation helps healthcare providers understand the broader context of a patient’s health, ultimately aiming to improve health outcomes and promote health equity.

ICD-10 Social Determinants of Health Z Codes Z55-Z65: Education and Literacy Problems

Digging deeper into social determinants of health z codes – code Z55 through code Z65 – we see they are related to socioeconomic topics such as education and literacy (code Z55), employment (code Z56), housing (code Z59), upbringing (code Z62), and family (code Z63). These codes are crucial for understanding and addressing health disparities, as well as understanding the impact of social determinants of health.

Understanding an individual’s primary support group is crucial for addressing mental health issues, as it significantly influences patient outcomes.

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

Due to the complexity and sensitivity of this information, CMS recommends4 choosing a suitable social determinants of health (SDOH) screening tool. Such tools enable rehab therapy care teams to collect data around social determinants of health and improve population health outcomes without increasing staff burden, making it part of the regular patient evaluation process and therefore important to eliminating health inequities pertaining to social determinants of health.

Making an initial decision about which Z code data will be most useful to monitor social determinants of health can make the process more succinct for your team while promoting health equity. A robust EMR or EHR solution will allow you and your team to seamlessly record data directly within patient records, improving population health for public health practitioners and helping to address health inequities effectively.

ICD-10 Z Codes for Housing and Economic Circumstances

ICD-10 Z Codes for housing and economic circumstances provide a detailed framework for documenting an individual’s living conditions and financial status. For example, Z59.0 is used to denote homelessness, while Z59.1 indicates inadequate housing. Economic circumstances are also covered, with codes like Z55.0 for unemployment and Z55.1 for changes in economic circumstances. These codes are essential for identifying potential health hazards related to housing and economic circumstances, allowing healthcare providers to track and address health disparities more effectively. By capturing this critical information, Z Codes help in formulating targeted interventions that can mitigate the adverse effects of poor housing and economic instability on health.

ICD-10 Z Code Updates in 2023

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 Z codes have been established to allow for greater specificity around issues that are social determinants of health. These updates reflect the influence of economic policies on health outcomes and health equity and have a large impact on social determinants of health.

For example, there are three new social determinants of health Z codes aim to promote health equity and improve public health by addressing economic policies. These social determinants of health concerns depict scenarios that may limit a patient’s ability to schedule, attend and/or pay for their rehab therapy appointments:

  • Transportation insecurity (code Z59.82) describes issues of inaccessible, inadequate, unaffordable, unsafe and unreliable transportation.
  • Financial insecurity (code 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 (code Z59.87), highlighting the importance of addressing broader social well-being and development agendas.

Addressing these social determinants of health with economic policies aims to improve health equity and patient and/or public health outcomes by eliminating public health inequities.

Benefits of Collecting SDOH Data for Health Equity

Primarily, social determinants of health (SDOH) data concerning public health outcomes 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, making community health assessment easier and improving health outcomes. These social determinants of health influence health outcomes and the right software, despite socioeconomic status, aim to improve population health and health equity for all, making positive health outcomes accessible to those in need.

Health promotion initiatives can also play a crucial role in addressing social determinants of health and supporting multi-sectoral partnerships to enhance public health outcomes, removing health disparities based on socioeconomic status and offering greater health equity.

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. Social determinants of health such as this one are not only addressable health disparities that have stood in the way of population health for those in lower socioeconomic status, but they were also troublesome for the practitioner who didn’t have better options to address health disparities due to social determinants of health.

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

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

Or what about code Z59.811 for addressing the public health disparity of housing instability? If a patient has experienced social determinants such as multiple moves, limiting 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. Collaborating with community partners, such as health departments and hospitals, can drive planning for community health assessment and health improvement.

Leveraging Z Codes for Healthcare Analytics

Leveraging Z Codes for healthcare analytics offers a powerful tool for gaining insights into the social and environmental factors affecting health. By analyzing data from Z Codes, healthcare providers can identify patterns and trends in health disparities, enabling them to develop targeted interventions to address these issues.

This data-driven approach not only helps in tracking the effectiveness of interventions but also highlights areas needing improvement. Furthermore, Z Code data can inform policy and regulatory decisions, advocating for changes that promote health equity. In essence, the strategic use of Z Codes in healthcare analytics can significantly enhance our understanding and management of social determinants of health.

Best Practices for SDOH Z Code Documentation

Implementing best practices for SDOH Z Code documentation is vital for accurately capturing the social and environmental factors impacting health.

Key practices include:

  • Utilizing standardized terminology and coding systems like ICD-10-CM.
  • Ensuring SDOH information is thoroughly documented in the patient’s medical record.
  • Employing Z Codes to capture comprehensive data on social and environmental health influences.
  • Analyzing Z Code data to uncover patterns and trends in health disparities.
  • Using this data to inform policy and regulatory decisions aimed at improving health equity.
  • Providing ongoing education and training for healthcare providers on the effective use of Z Codes and SDOH documentation.

By adhering to these best practices, healthcare providers can enhance the quality of SDOH data, ultimately contributing to better health outcomes and reduced health disparities.

Policy and Regulatory Considerations

Policy and regulatory considerations play a significant role in the effective use of SDOH Z Codes. The Centers for Medicare and Medicaid Services (CMS) mandate the use of Z Codes for certain healthcare services, emphasizing their importance. Additionally, the Health Insurance Portability and Accountability Act (HIPAA) requires the use of standardized coding systems like ICD-10-CM.

The Affordable Care Act (ACA) further underscores the need to address social determinants of health in healthcare. Organizations like the National Committee for Quality Assurance (NCQA) include SDOH in their Healthcare Effectiveness Data and Information Set (HEDIS) measures, while the American Medical Association (AMA) has developed guidelines for the clinical use of Z Codes. These policies and regulations of health sercices collectively support the integration of SDOH Z Codes into healthcare practice, promoting health equity and improving patient outcomes.

Net Health Therapy EHR Solutions Capture SDOH Data for Public Health Practitioners

All of our Net Health Therapy EHR solutions – Net Health TherapySource, Optima, and ReDoc – look to address social determinants of health and improve health equity by making it seamless to record and report via Z codes. Reducing health disparities We also provide technical support to assist health departments, community partners, and states in developing and testing health care payment and service delivery models.

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 social determinants of health focused tools promote health equity and improve public health by helping determine the information needed to eliminate social determinants or non medical factors hurting public health and personal well being.

They also help you record and track this information for your patients. The Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) tool, developed by the National Association for Community Health Centers, is one such example.

If you still have questions about collecting social determinants of health (SDOH) data and updating Z codes throughout your documentation, or you simply wish to learn more about our Net Health Therapy products, contact us today to schedule a 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

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