How hospitals can use Z codes to track social determinants of health

Z codes, which are ICD-10-CM codes used to identify non-medical factors that may affect a patient's health status, are a useful way to track social determinants of health and capture standardized data for Medicare beneficiaries. However, they are underused, with Z codes reported from only 1.59 percent of beneficiaries in 2019, according to a new CMS report

Z code documentation can be challenging for hospitals because they are not generally used for payment purposes, so there is no financial incentive to collect the data. The codes are also limited in scope, so they may not cover the full range of social and environmental health determinants. Given that these determinants are non-medical, care providers can feel limited in their power to help or are unaware of ways they can. Screening for and tracking social determinants of health is important, though, and can increase knowledge of how these hardships affect health outcomes, aiding future research and eventually solutions. It's therefore important that hospitals and health systems employ a standard approach for using Z codes. 

Here are steps outlined by CMS for using Z codes:

Data collection and documentation

Data can be collected by any member of a person's care team, including social workers, providers and nurses. It can be gained through screening, risk assessments, self-reporting and provider interactions. The data should then be recorded in the EHR or paper notes.

Mapping the data

The recorded data should then be mapped onto a Z code, which will standardize the information, making it easier to analyze. Billing and coding systems can help assign the appropriate codes.

Use and report

Analyzing the data can provide insights into patient outcomes and help improve care quality and coordination. The analyzed data are useful for leadership teams and boards to review to inform further care strategies. 

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