Social Determinants of Health

on Tuesday, 05 June 2018. All News Items | Case Management | Documentation | Coding

ICD-10-CM Coding from Non-Physician Documentation

“The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries.”

The Office of Disease Prevention and Health Promotion’s Healthy People 2020 initiative includes a Social Determinants of Health (SDOH) topic area. They note that “social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks…resources that enhance quality of life can have a significant influence on population health outcomes. Examples of these resources include safe and affordable housing, access to education, public safety, availability of healthy foods, local emergency/health services, and environments free of life-threatening toxins.”

In general, since the Wednesday@One focuses on topics related to Medicare Rules and Regulations in the acute hospital setting, you may be asking, this is interesting but what does it have to do with the hospital? Well, I am glad you “asked.”

ICD-10-CM codes included in categories Z55-Z65 identify patients with potential health hazards to socioeconomic and psychosocial circumstances. Information represented in this code block is information that would typically be identified by a Social Worker, Case Manager, or admitting nurse as a hospital begins the discharge planning process as soon as the patient is admitted.

In Coding Clinic for ICD-10-CM/PCS, First Quarter 2018, a question was asked to verify whether or not these codes could be assigned based on non-physician documentation. Advice given was that these codes represent social information and it would be acceptable to report them based on documentation from other clinicians following the patient.

To help you begin to understand what information is represented in these codes categories, the following table provides a high-level detail of the code categories and examples of codes within each category.

Codes Block: Persons with Potential Health Hazards Related to Socioeconomic and Psychosocial Circumstances
Code CategoryCategory DescriptionExamples of Codes in a Category
Z55 Problems Related to Education & Literacy Z55.0 Illiteracy & low level literacy Z55.4 Educational maladjustment & discord with teachers & classmates
Z56 Problems Related to Employment & Unemployment Z56.1 Change of Job Z56.2 Threat of Job Loss
Z57 Occupational Exposure to Risk Factors Z57.0 Occupational exposure to noise Z57.1 Occupational exposure to radiation
Z59 Problems Related to Housing & Economic Circumstances Z59.0 Homelessness Z59.4 Lack of adequate food & safe drinking water
Z60 Problems Related to Social Environment Z60.0 Problems of Adjustment to Life-Cycle Transitions (empty nest syndrome) Z60.2 Problems Related to Living Alone
Z62 Problems Related to Upbringing Z62.0 Inadequate parental supervision & control Z62.1 Parental overprotection
Z63 Other Problems Related to Primary Support Group, Including Family Circumstances Z63.0 Problems in relationship with spouse or partner Z63.1 Problems in relationship with in-laws
Z64 Problems Related to Certain Psychosocial Circumstances Z64.0 Problems with unwanted pregnancy
Z65 Problems Related to Other Psychosocial Circumstances Z65.0 Conviction in civil & criminal proceedings without imprisonment Z65.5 Exposure to disaster, war & other hostilities
Source: 2018 ICD-10 CM Tabular List of Diseases and Injuries at: https://www.cms.gov/Medicare/Coding/ICD10/2018-ICD-10-CM-and-GEMs.html

In MMP’s 2019 IPPS Proposed Rule series of articles, there was a related article discussing CMS’ efforts to account for social risk factors in several of the Hospital Quality Reporting Programs.

The Health People 2020 SDOH topic area has a goal to “create social and physical environments that promote good health for all.” A key to this is analyzing and acting upon data. As a hospital it is important that you begin to identify and utilize these codes.

If you are interested in learning more about SDOH’s, you can visit the Centers for Disease Control and Prevention (CDC) Social Determinants of Health web page at https://www.cdc.gov/socialdeterminants/.

Article by Beth Cobb

Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Services at Medical Management Plus, Inc.  Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. 

In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Risk Assessment (CRA) Tool. You may contact Beth at This email address is being protected from spambots. You need JavaScript enabled to view it..

This material was compiled to share information.  MMP, Inc. is not offering legal advice.  Every reasonable effort has been taken to ensure the information is accurate and useful.

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