The Importance of Z Codes in Health Care

Learn the importance of collecting data on social determinants of health (SDOH) with Z Codes

What are Z Codes?

• SDOH-related Z codes range from ICD-10-CM categories Z55-Z65 and are used to document SDOH data (e.g., food insecurity, housing, lack of transportation).

• Z codes refer to factors influencing health status or reasons for contact with health services that cannot be classified elsewhere as diseases, injuries or external causes.

What are SDOHs and why collect them?

• SDOH are the conditions in the environment where people are born, live, learn, work, play, worship, and age that affect a wide range of health and quality of life outcomes and risks.

• The World Health Organization (WHO) estimates that SDOH accounts for 30-55% of health outcomes.

• SDOH revenue can improve equity in health care delivery and research by:

  • Empower providers to identify and address health disparities (e.g., care coordination and referrals)

  • Support quality measurement

  • Support the planning and implementation of social needs interventions

  • Identify the needs of the community and population

  • Monitor the effectiveness of the SDOH intervention for patient outcomes

  • Use data to advocate for updating and create new policies

Using Z Codes for SDOH

• SDOH information can be collected before, during, or after a healthcare encounter through structured health risk assessments and screening tools.

• These codes should be assigned only when documentation specifies that the patient has an associated problem or risk factor that influences the patient's health.

• SDOH information can be collected through person-provider interaction or self-reported, as long as it is signed and incorporated into the medical record by a clinician or provider.

Z Code Update

• New SDOH Z codes can go into effect every April 1 and October 1. New codes are announced ahead of their effective date on the CDC website .

• Use the CDC National Center for Health Statistics to search for all available Z codes. Available at this link .

• Join the public process for the development and approval of SDOH codes through the ICD-10-CM Coordination and Maintenance Committee.

List of Z Codes

ICD-10 | Z code	Problems / Risk Factors Included in the Category
Z55 – Problems related to education and literacy	Illiteracy, lack of schooling, poor academic performance, less than a high school diploma, no general equivalency degree (GED), educational maladjustment, and discord with teachers and classmates.
Z56 – Problems related to employment and unemployment	Unemployment, job change, threat of job loss, stressful work schedule, discord with boss and coworkers, unpleasant work environment, sexual harassment at work, and military deployment status.
Z57 – Occupational exposure to risk factors	Occupational exposure to noise, radiation, dust, environmental tobacco smoke, toxic agents in agriculture, toxic agents in other industries, extreme temperatures and vibrations.
Z58 – Problems related to the physical environment	Inadequate supply of drinking water and lack of drinking water.
Z59 – Problems related to housing and economic circumstances	Protected homeless, unsheltered homeless, living on the street, inadequate housing, housing instability, discord with neighbors, tenants and landlords, problems related to living in residential institutions, inadequate food, lack of adequate food, insecurity food, extreme poverty, low income and insufficient social security and social support.
Z60 – Problems related to the social environment	Adaptation to life cycle transitions, living alone, difficulty in acculturation, social exclusion and rejection, target of adverse discrimination and persecution.
Z62 – Problems related to parenting	Inadequate parental supervision and control, parental overprotection, parenting away from parents, child in welfare custody, institutional parenting, hostility toward child and scapegoating, excessive and inappropriate parental pressure, personal history of abuse in childhood, personal history of childhood neglect, personal history of unspecified childhood abuse, parent-child conflict, and sibling rivalry.
Z63 – Other problems related to primary support group, including family circumstances	Absence of a family member, disappearance and death of a family member, disruption of the family through separation and divorce, dependent relative needing care at home, stressful life events affecting the family and home, stress in the family due to a family member's return from military deployment and alcoholism. and drug addiction in the family.
Z64 – Problems related to certain psychosocial circumstances	Unwanted pregnancy, multiparity and discord with counselors.
Z65 – Problems related to other psychosocial circumstances	Conviction in civil and criminal proceedings without imprisonment, imprisonment and other imprisonment, release from prison, other legal circumstances, victim of crime and terrorism, and exposure to disasters, wars and other hostilities.

SDOH data collection can improve equity in health care delivery and research by identifying and addressing health disparities, supporting quality measurement, and the planning and implementation of social needs interventions, among others.

If you are interested in learning more about the z codes and their implementation, consult with one of our representatives who are experts in the social determinants of health, by calling 787-294-5556 or arranging a demonstration.

Go.cms.gov/OHM