Insights Into the 5 Most Utilized “Z” Codes

Z codes are a set of ICD-10-CM codes used to report social, economic, and environmental determinants known to affect health and health-related outcomes. Z codes comprehensively identify non-medical factors affecting health and track progress toward addressing them.

Positive social, as well as economic and environmental, conditions are associated with a wide array of positive or improved patient medical outcomes and lower or reduced costs, while worse conditions negatively affect health and health-related outcomes, e.g. hospital readmissions rates, length of hospital stay, and use of post-acute care services

What are “Z” Codes?

  1. Z codes are a tool for identifying a range of issues related – but not limited – to education and literacy, employment, housing, ability to obtain adequate amounts of food or safe drinking water, and occupational exposure to toxic agents, dust, or radiation.
  2. Z codes can be used in any health setting (e.g., doctor’s office, hospital, skilled nursing facility (SNF) and by any provider (e.g., physician, nurse practitioner).

A report from CMS “Z Codes Utilization among Medicare Fee-for-Service (FFS) Beneficiaries in 2017,” indicates among the 33.1 million continuously enrolled Medicare FFS beneficiaries in 2019, 1.59% had claims with Z codes, as compared to 1.31% in 2016.

Key Findings:

The 5 most utilized Z codes were:

  1. Z59.0 Homelessness
  2. Z63.4 Disappearance and death of family member
  3. Z60.2 Problems related to living alone
  4. Z59.3 Problems related to living in a residential institution
  5. Z63.0 Problems in relationship with spouse or partner

In addition:

  • Beneficiaries dually eligible for Medicare and full-benefit Medicaid were overrepresented among the top 5 Z code claims.
  • Beneficiaries in rural areas were overrepresented (39.7%) among those with a Z59.3 – Problems related to living in a residential institution claim.
  • Male beneficiaries who accounted for 45.4% of the overall FFS population represented 67.1% of those with a Z59.0 – Homelessness claim.
  • Black and Hispanic beneficiaries accounted for 8.8% and 5.9% of the overall FFS population, respectively, but represented 24.8% and 9.2%, respectively, of those with a Z59.0 – Homelessness claim.
  • Most (49.6%) Z codes were billed on Medicare Part B non-institutional claims.
  • The top 5 provider types representing the largest proportions of Z codes were family practice physicians (15%), internal medicine physicians (14%), nurse practitioners (14%), psychiatry physicians (13%), and licensed clinical social workers (12%).

This data highlight provides a follow up to the previously published highlight, “Z Codes Utilization among Medicare Fee-for-Service (FFS) Beneficiaries in 2017,” (Mathew, Hodge, & Khau, 2020). Given that social, economic, and environmental determinants explain substantial variance in health and health-related outcomes, more widely adopted and consistent documentation of them is needed to comprehensively identify non-medical factors affecting health and to track progress toward addressing them; doing so could aid in work toward achieving health equity and ensuring highest quality and best-value care for all beneficiaries.

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