Video Transcript: Z Codes: Information for Coders

Coding for social determinants of health is challenging.

But there are solutions that can help.

Let’s go through some challenges and possible solutions.

You may feel like you don’t know enough about what Z codes cover or how to use them.

This course is a great introduction to social determinants of health and Z codes for coding professionals like you. You can review Lessons 1 and 2 for general information about Z codes.

You may not have time to code social determinants of health in addition to all the other diagnosis or procedure codes you need to input.

Talk to your manager about your facility’s electronic health record, or EHR functionality. Some EHR systems have modules that reduce the time it takes to code social determinants of health. These features may already exist in the EHR you use. Your management can ask the EHR vendor to turn these functions on and schedule a training on how to use them. We’ll discuss EHR systems later in this lesson.

If you can’t find the social determinants of health modules in your EHR, ask your facility’s management to contact your EHR vendor. Your facility’s EHR vendor can help you locate the modules and schedule team trainings on how to find social determinants of health questions and code responses.

Seeking reimbursement may feel challenging because Z codes aren’t first-listed or principal diagnoses. They also aren’t procedure codes. Many facilities aren’t reimbursed for capturing or coding social determinants of health.

CMS is making changes to address these reimbursement concerns, as discussed later in this lesson. One solution to this challenge is the fact that health care is moving toward value-based or alternative payment models that tie payment to quality and efficiency. Nearly all Medicare settings use these models, including hospitals and outpatient and post-acute facilities.

Some facilities are moving toward value-based accountable care models.

One additional challenge is that health care facilities may not have policies about the use of Z codes.

Health care facilities can work with other organizations, consider value-based reimbursement, and create policies with future changes in mind. Some facilities also may start collecting and coding social determinants of health data now in anticipation of a policy change. Coding professionals will play a vital role in coding and categorizing data supporting these changes.

The ICD-10-CM Official Guidelines for Coding and Reporting guides users in proper assigning and documenting Z codes.

The ICD-10-CM guidelines say you can assign as many Z codes as needed to describe a patient’s problems or risk factors.

But complete and thorough documentation must support all these codes as well.

The documentation must specify that a patient has an associated problem or risk factor.

For example, code Z60.2 involves problems related to living alone. But you shouldn’t assign code Z60.2 to every patient who lives alone.

Anyone who meets the definition of a clinician and is involved in the patient’s care can document social determinants of health for that patient.

You can assign Z codes based on documentation in a patient’s official medical record from:

• Social workers
• Community health workers
• Case managers
• Nurses
• Physicians
• And other providers and clinicians

Documentation can include patient self-reported information or data from any provider, including non-physicians, who work with the patient.

Make sure all providers’ documentation is clear and complete and supports the coding assignments.

We recommend you carefully review the ICD-10-CM Official Guidelines for Coding and Reporting before working with Z codes.

You can find links in the Reference tab to the research, guidelines, and studies discussed in this video.