The Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS) have updated the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code set with 11 new diagnosis codes describing social determinants of health (SDOH). The new Z codes were created to provide additional information regarding SDOH data such as housing, food insecurity, or transportation.
Z codes can be used in any health setting and by any provider as a tool for identifying a range of issues related to SDOH. Using SDOH Z codes can enhance quality improvement activities, track factors that influence people’s health, and provide further insight into existing health inequities.
Additional Z Codes Added
Below is a list of the new Z codes that have been added to the diagnosis classification:
- Under category Z55 (Problems related to education and literacy)
- 5 – Less than a high school diploma
- Under category Z58 (Problems related to physical environment)
- 6 – Inadequate drinking-water supply
- Under category Z59 (Problems related to housing and economic circumstances)
- 00 – Homelessness unspecified
- 01 – Sheltered homelessness
- 02 – Unsheltered homelessness
- 41 – Food insecurity
- 48 – Other specified lack of adequate food
- 811 – Housing instability, housed, with risk of homelessness
- 812 – Housing instability, housed, homelessness in past 12 months
- 819 – Housing instability, housed unspecified
- 89 – Other problems related to housing and economic circumstances
The new Z codes are aligned with standardized screening questions and answers included in such assessments as the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE), the Accountable Health Screening Tool, or the Health Leads Screening Tools. Definitions for homelessness and housing instability have been provided by the Gravity Project, a multi-stakeholder public collaborative with the goal to develop, test, and validate standardized SDOH data for use in patient care, care coordination between health and human services sectors, population health management, public health, value-based payment, and clinical research.
Clarification of Clinician: ICD-10-CM Official Guidelines for Coding and Reporting Updates
In addition, the FY 2022 ICD-10-CM Official Guidelines for Coding and Reporting provide a clarification of the term “clinician” in the section in Section 17 Social Determinants of Health, to clarify who can assign codes that are based on medical record documentation.
Codes describing social determinants of health (SDOH) should be assigned when this information is documented. For social determinants of health, such as information found in categories Z55-Z65, Persons with potential health hazards related to socioeconomic and psychosocial circumstances, code assignment may be based on medical record documentation from clinicians involved in the care of the patient who are not the patient’s provider since this information represents social information, rather than medical diagnoses. For example, coding professionals may utilize documentation of social information from social workers, community health workers, case managers, or nurses, if their documentation is included in the official medical record.
Patient self-reported documentation may be used to assign codes for social determinants of health, as long as the patient self-reported information is signed-off by and incorporated into the medical record by either a clinician or provider.
For additional information on Z codes and how to use them, review our Utilization of Z Codes for Social Determinants of Health among Medicare Fee-for-Services Beneficiaries data highlight and our Using Z Codes: The Social Determinants of Health (SDOH) Data Journey to Better Outcomes. See the ICD-10-CM Official Guidelines for Coding and Reporting FY 2022 for guidance on ICD-10-CM coding.