Z-Codes Capture Health-Related Social Needs

Care providers use certain codes to document a patient’s physical symptoms, diagnoses, and services received. Known as “ICD-10” codes, they are listed in individuals’ electronic health records (EHRs) and on claims submitted to health plans. The ICD-10 Z-codes are a subset of those codes that document health-related social needs (HRSN), such as unemployment or housing instability.

What Are Z-codes?

Most ICD-10 codes focus on defining physical conditions, diagnoses, and treatment. Z-codes present a standardized format for information on social needs that affect health. Education, health literacy, employment, housing, and economic factors are among the social drivers of health that have corresponding Z-codes.

What Information do Z-codes Capture?

An emphasis on whole health — physical, behavioral, and social needs — continues to evolve across the healthcare industry. Documenting a patient’s physical and behavioral conditions has been routine for all different care providers, but social needs have not received the same level of attention or documentation.

Z-codes are a uniform, industry-accepted method of capturing what people experience outside of care providers’ offices — which drives 80% of health. Too often, social needs go unnoticed and undocumented. When health-related social needs are known, solutions can be identified or developed to address them.

Z-codes also make it easier to aggregate data to help us understand a community’s health more holistically, which can inform policy, identify resources, and improve partnerships between providers and community-based organizations that collectively address unmet health-related social needs.

Who Can Assign Z-codes?

The process of assigning a Z-code starts with talking to a person about what challenges they experience in their lives. Making the time to listen and learn about what a person is experiencing can bring health-related social needs to light. This can be done during a face-to-face conversation or with a questionnaire – also known as an assessment.

Z-codes are mainly submitted through medical claims. Z-code information can be documented by many different health care professionals, including:

• Health care providers
• Social workers
• Case and care managers
• Community health workers
  
  

Where Is the List of Z-codes?

The list of Z-codes is included with the ICD-10-CM codes. The Z-code list includes, but is not limited to:

• Z55 – Education and Literacy
• Z56 – Employment and Unemployment
• Z58 – Physical Environment Risks
• Z59 – Housing and Economic Conditions
• Z60 – Social Environment
• Z62 – Upbringing
  
  

How Are Z-codes Used?

Z-codes identify additional factors occurring outside of care providers’ offices that contribute to a person’s overall health. Understanding what challenges people experience can help care providers modify treatment plans or make recommendations to help achieve the best outcomes. As one example, care providers might use telehealth visits for a patient who doesn’t have access to transportation and submit prescriptions to pharmacies that deliver.

The information captured by Z-codes can provide an overview of the social drivers of health experienced by individuals as well as their communities. Community planners and policymakers can develop programs and policies to address identified needs.

How Does Elevance Health Use Z-codes?

Elevance Health and its affiliated health plans take a whole-health approach. Elevance Health programs that identify social needs and deliver solutions include:

• Employing community care workers to engage with members either by telephone or through home visits to identify their health-related social needs in states served by Elevance Health’s affiliated healthcare plans. The care workers help to connect the member to the right benefits or community services that can address the health-related social needs that get in the way of their health and healthcare.
• Activating a social resource call center available to over 350,000 Missouri Medicaid members. Social resource specialists speak with members to identify their questions or concerns, then connect them with information, services, and community resources.
• Removing social barriers through pharmacy care. Elevance Health’s CarelonRx Pharmacy Care Center is staffed with 400 pharmacists and pharmacy technicians who help remove financial, transportation, and access barriers, which improves adherence with medication treatment plans. They proactively reach out to people who haven’t picked up prescriptions or who are taking multiple medications.
• Incorporating the myNEXUS Social Drivers program into the Complex Discharge Planning, Early Interventions, Care Transitions, and Member Connect programs. It provides in-home social drivers of health risk assessments and resource connectivity to help remove social barriers and improve care coordination and delivery — reducing hospitalizations and ER visits as a result.
• The Whole Health Index (WHI) uses Z-codes to account for social factors driving health. Using consumer- and area-level data from 93 measures of health in the three domains of global health, social drivers, and clinical quality, WHI makes it possible to better understand where there are gaps affecting the well-being of individuals and groups of people.

“A whole-health approach requires treatment plans that look beyond clinical conditions,” said Dr. Shantanu Agrawal, chief health officer of Elevance Health. “It’s a systemic shift in thinking — a team approach to care that addresses physical, behavioral, and social drivers of health.”

Z-codes are one way to gather, document, and quantify information to address SDOH in addition to physical health conditions to improve our overall health and well-being.