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24-397m Use the Most Descriptive SDOH Z Codes on Claims and Encounters
Date: 04/22/24
Help plan and coordinate personalized care with the most reliable data as it relates to your patients
The Department of Health Care Services’ social determinants of health (SDOH) codes are based on ICD-10-CM1 Z diagnosis codes. These codes are used to help close the gap in identifying health disparities and their root causes to provide better care to underserved individuals.
Z code categories
The SDOH Z Codes start at Z55 to Z65 – persons with potential health hazards related to socioeconomic and psychosocial circumstances.
The categories include:
- Z55 – Problems related to education and literacy.
- Z56 – Problems related to employment and unemployment.
- Z57 – Occupational exposure to risk factors.
- Z58 – Problems related to physical environment.
- Z59 – Problems related to housing and economic circumstances.
- Z60 – Problems related to social environment.
- Z62 – Problems related to upbringing.
- Z63 – Other problems related to primary support group, including family circumstances.
- Z64 – Problems related to certain psychosocial circumstance.
- Z65 – Problems related to other psychosocial circumstances.
Select the most descriptive code(s)
There are additional diagnosis codes found under the main categories for Z55, Z58, Z59, and Z62. When using these four categories, you must drill down to the most descriptive Z code before adding it to the member’s medical chart and to a claim or encounter. Select as many Z codes as necessary to fully document the patient’s circumstances.
Example: if a person lives in a home but is without utilities, use code Z59.12 – inadequate housing utilities instead of Z59.1 – inadequate housing.
For more information, refer to Resources below.
Resources
Centers for Medicare & Medicaid Services (CMS) –
- Improving the Collection of Social Determinants of Health (SDOH Data with ICD-10-CM Z Codes)
- Using Z Codes: The SDOH Data Journey to Better Outcomes
1 ICD-10-CM – International Classification of Diseases, Tenth Edition, Clinical Modification
Additional information
Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569. Behavioral Health providers can call at 844-966-0298.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.