Coding Corner: Z-codes for Documentation of Care Related to Social Determinants of Health | Rebekah Summey

Rebekah Summey, MD

Z codes are diagnosis codes found in Chapter 21: Factors Influencing Health Status and Contact with Health Services. Codes Z55-Z65 were created specifically to track social determinants of health (SDoH) including housing, food insecurity, transportation, etc.

Why are these codes important?

1. Trackable documentation of SDoH allows for improved quantification of barriers and creates opportunities for systematic improvements. The specific SDoH that create barriers to health and optimal outcomes for your patients may be particularly salient.
2. Specific documentation of your services, including your efforts to address adverse social determinants of health, highlight the complexity of your care.

Case 1

A 60-year-old patient with serous endometrial cancer presents for her postoperative appointment. You recommend chemotherapy. Your counseling time is 200% longer than expected due to poor health literacy.

Coding: You add a diagnosis code of Z55.6 (Problems related to health literacy) to the list of diagnoses managed during this visit.

Case 2

A 45-year-old cervical cancer patient has been late to or missed half of her radiation appointments in the past 2 weeks. You counsel her on the importance of staying on track. She discloses that her car broke down, she doesn’t have money to fix it, and the bus is unpredictable. She is having trouble getting to work on time and is nervous about keeping her job, thus making it even harder to keep her appointments. You work with your team to help her find medical transportation resources, provide her documentation for work, and communicate with your radiation oncologist.

Coding: You add the following diagnosis codes to the list of diagnoses that you managed during this visit:

• Z59.82 Transportation insecurity
• Z59.6 Low income
• Z56.2 Threat of job loss

Additionally, you include time and effort spent counseling and coordinating care in your MDM or time-based E/M coding.

Case 3

A 70-year-old ovarian cancer patient currently receiving adjuvant chemotherapy has lost weight since her last visit. In addition to decreased appetite and taste, she reports that her husband moved out three weeks ago. They had been fighting about how best to support their son, who struggles with drug abuse. You provide emotional support, nutritional counseling, and refer her to a dietician.

Coding: You add the following diagnosis codes to the list of diagnoses that you managed during this visit:

• Z59.4 Lack of adequate food
• Z63.0 Problems in relationship with spouse or partner
• Z63.72 Alcoholism or drug addiction in family

The full list of ICD-10 codes regarding social determinants of health can be found in the 2024 ICD-10-CM Coding Manual. ASCO has also published a helpful list that can be found here.