Data & Reimbursement Committee Coding Tip: What Are Z-Codes?

June 2021
By Erin Leighton, RHIT

Social Determinants of Health (SDOH for short) are one of today’s most widely discussed topics in healthcare. But what are they and why are they important? How are they classified and who is most qualified to document them in the medical record?

The U.S. Department of Health and Human Services website defines SDOH 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.” SDOH capture is becoming a hot button with providers and payers as a way to reduce costs while increasing quality of care. According to an article on SDOH that appeared April 6, 2021 in the Journal of AHIMA, “SDOH have been shown to have a far greater impact on a patient’s health outcomes than either the clinical care provided or genetic factors.”

SDOH are often broken into five key domains: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context. Common examples of SDOH can be homelessness, isolation, limited access to education and food, unemployment, etc.

Z-Codes were developed in order to capture SDOH details about each patient.

  • Z55 – Problems related to education and literacy
  • Z56 – Problems related to employment and unemployment
  • Z57 – Occupational exposure to risk factors
  • Z59 – Problems related to housing and economic circumstances
  • Z60 – Problems related to social environment
  • Z62 – Problems related to upbringing
  • Z63 – Other problems related to primary support group, including family circumstances
  • Z64 – Problems related to certain psychosocial circumstances
  • Z65 – Problems related to other psychosocial circumstances

Screening, documenting, and coding these details allows a healthcare entity to track and monitor trends across the population it serves, often leading to increased opportunity for interventions.

Originally, SDOH could only be documented by clinicians, but in recent years, the American Hospital Association worked to better define who is qualified to screen for and document the social needs of patients. “In early 2018, the AHA Coding Clinic published advice clarifying that codes from categories Z55-Z65 can be assigned based on information documented by all clinicians involved in the care of the patient.” The following year, the AHA took additional steps to better define “clinicians” by arguing that this category can “include anyone deemed to meet the requirements, set by regulation or internal hospital policy, to document in the patient’s official medical record.” So, depending on the facility you work for, this can now include case managers, nurses, discharge planners, social workers, etc.

Today, there are many national initiatives that are gaining ground with regard to SDOH, including Healthy People 2030 and The Gravity Project. As stewards of the medical record, regardless of setting, we can help by educating the health care team about screening for SDOH and appropriately documenting it. We can also utilize Z-codes so that SDOH can be tracked for trends. Additionally, key stakeholders and healthcare leaders can help coders by allowing extra time to capture SDOH when reviewing the record.


June 2021 Coding Tip Sources: