New Z Codes Capture More Social Determinants of Health
- By Renee Dustman
- In CMS
- February 1, 2023
- 2 Comments
The April 2023 update to ICD-10-CM expands SDOH data reporting capabilities.
Several new Z codes for reporting social determinants of health (SDOH) will be added to the ICD-10-CM code set in the 2023 first quarter update. Make sure everyone in your physician practice is familiar with the newly codified factors that may be influencing the health status of patients.
What Are SDOH?
Social determinants of health are defined by the Centers for Medicare & Medicaid Services (CMS) as “… the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” The CMS Framework for Health Equity includes five priorities, and SDOH are a component of the first priority: to expand the collection, reporting, and analysis of standardized data.
When documented, SDOH are reported with Z codes (Z55-Z65) from Chapter 21 of the ICD-10-CM code set. This category of codes has expanded every year since first created in fiscal year 2016, and this year is no exception.
New SDOH Codes
Among several other new codes that will go into effect April 1 are the following new Z codes for reporting certain social determinants of health:
Z55.6 Problems related to health literacy
Z58.81 Basic services unavailable in physical environment
Z58.89 Other problems related to physical environment
Z59.10 Inadequate housing, unspecified
Z59.11 Inadequate housing environmental temperature
Z59.12 Inadequate housing utilities
Z59.19 Other inadequate housing
Z62.814 Personal history of child financial abuse
Z62.815 Personal history of intimate partner abuse in childhood
You will use these codes to report SDOH information collected by clinical or other qualified office staff, or self-reported by the patient, in accordance with the ICD-10-CM Official Guidelines for Coding and Reporting. According to the American Hospital Association, “If the patient self-reported information is signed-off and incorporated into the medical record by a clinician, that information can support the use of a Z code by coding professionals.”
You will also find in the April update new codes being added at T74.A- and T76.A- to describe confirmed or suspected child or adult financial abuse; at Y07.0- and Y07.44-Y07.54 to describe perpetrators of maltreatment and neglect; and at Z91.1- to describe a patient’s noncompliance with medication or renal dialysis for various reasons.
In the October 2022 update to ICD-10-CM, three new Z codes were added for transportation insecurity (Z59.82), financial insecurity (Z59.86), and material hardship (Z59.87).
Check the EHR
Electronic health record systems (EHRs) are not always updated expediently. If your office or facility reports social determinants of health data to the government, making sure these new codes have been added to your EHR, and that your practice is collecting this latest information, will permit proper SDOH coding.
Resources:
ICD-10 Coordination and Maintenance Committee Meeting, Sept. 13-14, 2022, www.cdc.gov/nchs/data/icd/Topic-packet-September-2022.pdf
HHS. Healthy People 2030. https://health.gov/healthypeople/priority-areas/social-determinants-health
AHA. ICD-10-CM Coding for Social Determinants of Health. Jan. 2022.
www.aha.org/system/files/2018-04/value-initiative-icd-10-code-social-determinants-of-health.pdf
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Is there a requirement to code SDOH ? I am hearing this starts in April 2023 but have not had guidance on who is required to report?
There is no legal requirement to report SDOH codes. Your employer and/or payer may put a policy in place, however, which you should reference.