Optimizing ICD-10-CM “Z codes” for Social Determinants of Health with Technology

News | June 18th, 2021

The COVID-19 pandemic brought conversations about healthcare inequities and Social Determinants of Health (SDOH) to the forefront. How can we account for factors such as education, employment, housing or transportation needs in care decisions? What role should technology play? We know SDOH contributes to population health outcomes. Fortunately, codes exist to document SDOH and other non-medical factors affecting patients’ health. Unfortunately, the underutilization of these analytics, such as “Z codes,” within healthcare systems, stands as a barrier to the identification of population health trends and more efficient management of care.

Understanding Z Codes for Social Determinants of Health

Z codes Z00-Z95 are a subset of ICD-10-CM (clinical modifications) codes. The codes can be attached to medical claims and are used to explain various non-medical factors influencing health status. The diagnosis codes are used when patients do not have a known disorder and represent reasons for encounters with health services. While the tool is available, the use of Z codes is often seen as low priority in the clinical setting.

The Centers for Medicare and Medicaid Services (CMS) released a report in January 2020 stating that Z55-Z65, assess and help account for patients’ social determinants of health (SDOH). SDOHs refer to the conditions that an individual is immersed in that include aspects of their social, physical, and economic environment. SDOH determine health inequalities and are important predictors of clinical care. Codes Z55-Z65 break down into sub-codes that can provide a more detailed reporting of SDOH.

In April 2019, UnitedHealthcare and the American Medical Association added over 20 new Z code sub-categories in an effort to further implement the use of Z codes to assess SDOH. Additionally, the American Hospital Association (AHA) Coding Clinic published guidelines and advice for documenting social (versus medical) information.

Aspects of everyday life such as socioeconomic status, education level, marital status, place of residence, exposure to risk factors, and access to transportation systems are now accounted for within SDOH data. Yet healthcare providers still face a lack of knowledge, familiarity, and standardization of SDOH data collection. The accumulation of what could be robust and useful data is not being capitalized on.

The Importance of Interoperability to Capture SDOH

One challenge to overcome in order to implement SDOH Z Codes is a lack of interoperability between technology systems like third-party SDOH tools and Electronic Health Records (EHRs).

Thankfully enhancing interoperability has been a key priority of government healthcare officials culminating in the passing of the 21st Century Cures Act. As of April 5, 2021, the Office of the National Coordinator (ONC) finalized rules as part of the Cures Act to prevent illegal information blocking and to streamline the secure sharing of patient data amongst and between patients and their providers--including SDOH data. The new interoperability mandates make it possible to employ a standardized approach that utilizes technology to virtually screen for non-medical factors that influence a patient’s health. Standardized data collection and sharing will aid healthcare providers in the identification of individuals who face health inequality or need better access to healthcare resources, and will help data analysts understand the relationship between SDOH and medical outcomes.

The Rimidi platform supports the virtual collection of Patient Reported Outcomes and Social Determinants of Health with the capability to write that data back to the EHR for inclusion in care decisions. To learn more about our approach to SDOH, contact us today.