December 9, 2024, Volume 1, Issue 4

As pediatricians, we are familiar with Social Determinants of Health (SDoH) and know Health-Related Social Needs (HRSN) impact many of our developing patients. What you may not realize is that an estimated 80% of modifiable health outcomes are influenced by SDoH!

Improved screening efforts are underway at Nationwide Children’s Hospital – Toledo for 2025! Be on the lookout for updated tools and initiatives implementing once the new year arrives.

Screening for unmet social needs helps to:

• Remove barriers and help connect families to community resources
• Help children become healthier by addressing things in their
  environment that impact health
• Ensure every child/family has access to care and can be their best self
• Get best outcomes for patients

When identifying SDoH, use Z-codes (Z55-Z65) to record and help collaborate care with other providers. Using the Z-codes also helps build and improve our population health data. It’s all about IMPACT!

In the next few pages, you’ll find a comprehensive list of current SDoH Z-codes and tips for incorporating SDoHs into your professional work.

ICD-10-CM Z-Codes

Z-codes have multiple subcategories, with specific selections included here that you may find useful in clinical practice.

Z55 – Problems related to education and literacy

· Z55.5 – Less than a high school diploma

Z56 – Problems related to employment and unemployment

· Z56.3 – Stressful work schedule

Z57 – Occupational exposure to risk factors

· Z57.0 – Occupational noise

Z58 – Problems related to physical environment

· Z58.6 – Inadequate drinking-water supply

Z59 – Problems related to housing and economic circumstances

· Z59.0 – Homelessness

· Z59.01 – Sheltered homelessness

· Z59.02 – Unsheltered homelessness

· Z59.1 – Inadequate Housing

· Z59.11 – Inadequate housing environmental temperature

· Z59.12 – Inadequate housing utilities

· Z59.4 – Lack of adequate food

· Z59.41 – Food insecurity

· Z59.8 – Other problems related to housing and economic circumstances

· Z59.812 – Housing instability, housed, homelessness in past 12 months

· Z59.82 – Transportation insecurity

· Z59.86 – Financial insecurity

Z60 – Problems related to social environment

· Z60.4 – Social exclusion and rejection

· Z62.24 – Child in custody of non-relative guardian 

Z62 – Problems related to upbringing

· Z62.2 – Upbringing away from parents

· Z62.23 – Child in custody of non-parental relative 

· Z62.8 – Other specified problems related to upbringing

· Z62.81 – Personal history of abuse in childhood

· Z62.82 – Parent-child conflict

· Z62.823 – Parent-step child conflict

· Z62.83 – Non-parental relative or guardian-child conflict

· Z62.831 – Non-parental relative-child conflict

· Z62.832 – Non-relative guardian-child conflict

· Z62.833 – Group home staff-child conflict

· Z62.89 – Other specified problems related to upbringing

· Z62.892 – Runaway

Z63 – Other problems related to primary support group, including family circumstances

· Z63.5 – Disruption of family by separation and divorce

Z64 – Problems related to certain psychosocial circumstance

Z65 – Problems related to other psychosocial circumstances

Additional Z-codes & information can be found at:

CDC ICD-10-CM Tool –  icd10cmtool.cdc.gov

Improving the Collection of SDoH Data with ICD-10CM Z codes: www.cms.gov/files/document/cms-2023-omh-z-code-resource.pdf

Example Case: A 5-year-old patient comes in for a sick visit for a sore throat.  You note delayed vaccinations, and the child has missed and rescheduled multiple appointments. The patient’s
mother reveals the family automobile has broken down, and they are having transportation troubles. You connect mother with
transportation resources and develop an immunization catch-up plan.

Visit Diagnoses:
•  J02.9 (acute pharyngitis)
•  Z28.39 (other under immunization status)
•  Z59.82 (Transportation Insecurity)

Documenting & Coding Z-Codes

Z-codes are underutilized in the medical record. Proper documentation and attribution of health-related social needs (HRSN) during a patient visit is integral to improving
patient care, and building a robust, accurate population health database.

Z-codes help characterize HRSN that impact patient complexity and time spent to properly address them during care. The 2021 and 2023 AMA and CPT E/M revisions include SDOH in the “risk” column, highlighting an increased morbidity risk when SDoH significantly limit the problem(s) addressed at the visit.  The AAP advises to clearly document the influence the identified SDoH has on your patient’s diagnosis and treatment in the assessment and plan, and also to code the SDoH using relevant Z-codes.

When ordering diagnoses, the primary diagnosis remains the main problem addressed, while the secondary Z-code may influence the risk complexity level for the visit.

There may be times when a provider is addressing SDoH factors without a specific correlating diagnosis. You should still document the SDoH factor that was addressed to support moderate risk for the element of ‘Risk of Complications, Morbidity, or Mortality in Patient Management.’