New CMS Infographic Details Using Z Codes to Document SDOH

CMS has identified five Health Equity Priorities for Reducing Health Disparities as part of its Framework for Health Equity. The new tool — an infographic emphasizing the importance of using Z codes to document SDOH data — aligns with the first priority, which calls for expanding and optimizing the collection, reporting and analysis of standardized SDOH data.

A subset of ICD-10-CM codes, Z codes refer to factors that influence a patient’s health status or their reasons for seeking care that cannot otherwise be classified as diseases, injuries or other external causes. Z code categories Z55-Z65 are specifically used to document SDOH data (e.g., issues related to education, literacy, employment, housing, etc.) so the information can be used to can enhance quality improvement, track factors that influence health, and offer insight into existing health inequities.

The infographic outlines several factors health care professionals should keep in mind when gathering and documenting SDOH data, such as: 

• Information about SDOH can be collected before, during or after a health care encounter through structured health risk assessments and screening tools.
• SDOH data can be collected via patients’ interaction with health care professionals or it can be self-reported, as long as it is verified by the clinician and incorporated into the official medical record.
• It is important to screen for SDOH at each health care encounter to pinpoint circumstances that may have changed since the patient’s previous visit.
• Coding professionals may utilize documentation of social information from social workers, community health workers, case managers or nurses, as long as the documentation is part of the official medical record.
• Z codes should be assigned only when the documentation specifies that the patient has an associated problem or risk factor that influences the patient’s health. 

In addition to offering these process tips, the infographic highlights Z codes the agency most recently added (i.e., in April), as well as a number of codes scheduled to go into effect in October.

A second infographic — previously produced but updated in June — details the steps involved in collecting and documenting SDOH data, mapping it to the appropriate Z codes, using the data to identify social risk factors and unmet needs, and reporting data findings to external entities to identify opportunities for advancing health equity.

This resource also lists important steps in utilizing Z codes to enhance quality improvement activities from the perspective of three distinct user groups: health care administrators, members of the health care team, and coding and other professionals.

Learn more about CMS’ health equity programs, research and resources, and review an April 2022 Data Highlight from the agency titled “Utilization of Z Codes for Social Determinants of Health Among a Sample of Medicare Advantage Enrollees, 2017 and 2019.” Visit the CDC website for a comprehensive listing of the latest ICD-10-CM coding files, including Z codes.