Practicing Medicine SDOH Toolkit Coding for SDOH

Coding for SDOH

Business of Medicine

Coding for social determinants of health

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.

Examples of patient experiences related to SDOH:

  • Patient returns to the office today having missed the last two scheduled appointments due to difficulties with transportation. Patient has been out of medications for several weeks and has presented to a local Emergency Department at least once for associated symptoms.
  • Patient has recently been evaluated by orthopedics for bilateral knee pain. Found with severe tricompartmental degenerative disease, total knee replacements were advised. Scheduling surgery is delayed due to patient’s morbid obesity and continued daily tobacco use.
  • Patient was prescribed additional anti-hypertensive agents on the last visit, however was unable to afford them and has continued taking prior medications. Blood pressure has been very high when checked at the local fire station.

Established ICD-10 Z codes

Select a code below to view problems/risk factors included in each category

Z55: Problems related to education and literacy

Illiteracy/low-level, schooling availability, failing school, underachievement, discord with teachers.

Z56: Problems related to employment/unemployment

Changing of job, losing job, no job, stressful work schedule, discord with boss/co-workers, bad working conditions.

Z57: Occupational exposure to risk factors

Noise, radiation, dust, other air contaminants, tobacco, toxic agents in industry, extreme temperatures, vibration, others.

Z59: Problems related to housing and economic circumstances

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.

Z60: Problems related to social environment

Adjustment to life-cycle transitions, living alone, cultural differences, social exclusion and rejection, discrimination/persecution.

Z62: Problems related to upbringing

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.

Z63: Other problems related to primary support group, including family circumstances

Spousal conflict, in-law conflict, absence of family member (death, divorce, deployment), dependent relative needing care, family alcoholism/drug addiction, isolated family.

Z64: Problems related to certain psychosocial circumstances

Unwanted pregnancy, multiparity, discord with counselors.

Z65: Problems related to other psychosocial circumstances

Civil/criminal convictions, incarceration, problems after release from prison, victim of crime, exposure to disaster/war, religious persecution.

SDOH coding resources from CMS

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.

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