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Key things to know about Z codes and their impact on health equity

Social determinants of health (SDOH) have gained increased interest in recent years, but until recently, there has been little documentation on SDOH to support health equity initiatives. One readily available way providers can analyze their SDOH data is the use of Z codes.

We recently partnered with Humana to examine the utilization of SDOH Z codes across patient characteristics, to identify which codes are used most often and which providers are documenting them.

What are Z codes and how do they support SDOH documentation?

Z codes are a set of psychosocial risk and economic determinant-related codes within the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Z55.0-Z65.0. There are nine categories of codes, each with their own set of subcodes.

The nine Z code categories are:

  1. Z55: Problems related to education and literacy
  2. Z56: Problems related to employment and unemployment
  3. Z57: Occupational exposure to risk factors
  4. Z59: Problems related to housing and economic circumstances
  5. Z60: Problems related to social environment
  6. Z62: Problems related to upbringing
  7. Z63: Other problems related to primary support group, including family circumstances
  8. Z64: Problems related to certain psychosocial circumstances
  9. Z65: Problems related to other psychosocial circumstances

Each of these categories highlights common challenges that patients experience in their family, community, and other social settings, often affecting their health either directly or indirectly. Leveraging these Z code categories and the subcodes within those categories can help identify and document social risk factors that may require different approaches to care delivery.

Building health equity initiatives with Z codes

All clinicians involved in the care of a patient can document Z codes, however, their utilization largely varies – so the first step in enhancing health equity with this information is utilization.

When captured, Z codes can help health plans and providers deliver higher quality care by painting a clearer picture of their member populations – and can be analyzed by gender, race/ethnicity, age, geographic location, SDOH characteristics, and more. This allows for better resource utilization and more focused member outreach efforts.

At an individual level, Z codes can be linked to Medicare Advantage (MA) beneficiaries through advanced data analytics and standardization methods, enabling member-level understanding of the SDOH factors that are affecting individual patients’ care journeys.

How to improve utilization of Z codes and create better care outcomes

As the Medicare Advantage population continues to rise, the importance of Z code utilization in understanding SDOH characteristics and driving health equity will grow as well.

Collection of this data is instrumental, but harnessing it to improve health equity is more important. Pulling SDOH data into any healthcare research is necessary to understand the full picture of the patient and what may be causing adverse health outcomes other than only what is presented in the doctor’s office.

How does a patient’s home life, income, social support, education level, environment, or community impact their health? Which of these factors cause worse outcomes in chronically ill patients? Which factors are the most important? How can we address these challenges?

These questions and more can be answered with data analytics that include a view of all possible factors affecting health.

To learn more about how Z codes can unleash population health insights, check out this study on improving Z code utilization to better understand SDOH and improve care.

Or, if you want to incorporate SDOH data into your organizational goals, explore our SDOH Market Insights.

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By Inovalon