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Get the latest updates and resources for using ICD-10 Z codes for SDOH
In January 2021, several changes were made to the descriptions of the outpatient Evaluation and Management (E&M) codes. Level of service can now be determined by either total time spent on patient care on the calendar day of service, or by the level of Medical Decision Making (MDM). Diagnosis or treatment limited by Social Determinants of Health (SDOH) is an element in either the Moderate (99204 / 99214) or the High (99205 / 99215) levels of MDM.
Documentation of SDOH elements in the medical record increase the correct level of coding and should be considered carefully. The Z-codes are not presently included in many electronic medical record systems for explicit entry, but the appropriate documentation should be entered in the chart and the level of billing adjusted accordingly.
Select a code below to view problems/risk factors included in each category
Illiteracy/low-level, schooling availability, failing school, underachievement, discord with teachers.
Changing of job, losing job, no job, stressful work schedule, discord with boss/co-workers, bad working conditions.
Noise, radiation, dust, other air contaminants, tobacco, toxic agents in industry, extreme temperatures, vibration, others.
Homeless, inadequate housing, discord with neighbors/landlord, problems with residential living, lack of adequate food/safe drinking water, extreme poverty, low income, insufficient social insurance/welfare support.
Adjustment to life-cycle transitions, living alone, cultural differences, social exclusion and rejection, discrimination/persecution.
Inadequate parental supervision/control, parental overprotection, upbringing away from parents, child in custody, institutional upbringing (orphan or group home), hostility towards child, inappropriate/excessive parental pressure, child abuse including history of (physical and/or sexual), neglect, forced labor, child-parent conflict.
Spousal conflict, in-law conflict, absence of family member (death, divorce, deployment), dependent relative needing care, family alcoholism/drug addiction, isolated family.
Unwanted pregnancy, multiparity, discord with counselors.
Civil/criminal convictions, incarceration, problems after release from prison, victim of crime, exposure to disaster/war, religious persecution.
The following graphics produced by the Centers for Medicare & Medicaid Services outline the steps for using Z codes in your practice to document SDOH data. Click on a graphic below to open a downloadable PDF.
