Q&A: Coding the social determinants of health

October 2, 2019
Medicare Web

Q: Which codes need to be used when billing for the social determinants of health?

A: The ICD-10-CM codes Z55–66 are referred to as Z codes, or more informally as stress codes. They reflect psychosocial challenges occurring for clients at the individual, family, and community levels. These unique codes encompass stress in the form of relationships, the environment, the community, difficulty in learning, difficulty at work, economic stress, or even caregiver burden. Expanding the focus of the codes allows exploration of critical elements that drive health and behavioral health, especially in the context of evolving reimbursement initiatives.

Now, keep in mind that these particular Z codes have been part of the industry for the past several years, although they were not being utilized. Despite the availability of these ICD-10-CM codes, recent studies show they were infrequently utilized in inpatient settings for discharges other than those related to mental health and alcohol/substance use (AHA, 2018). In the scope of the social determinants, using the specific ICD-10-CM Z, or stress, codes is a must.

For more information, see The Social Determinants of Health: Case Management's Next Frontier.