At a Glance: New Z-Codes for SDOH

A handy guide to commenting on proposed ICD-10 changes


The biggest headline last week for Social Determinants of Health (SDOH) Innovators was the announcement that UnitedHealthcare (UHC) and the American Medical Association (AMA) proposed a new set of ‘Z-codes’ for the ICD-10 coding system used in clinical diagnosis and billing at virtually every health insurer and doctor’s office across the country.

Some background reading on Z-codes and ICD-10

If approved by the Centers for Disease Control and Prevention (CDC), these new codes represent a much more granular approach to documenting SDOH. If enacted and adapted properly, this would enable more precise and relevant social interventions for patients and families, more efficient use of existing resources and programs, and a better sense of SDOH’s role in value-based care payment/performance models.

As with most health IT policy, SDOH data integration has many wrinkles; expanding ICD-10 Z-codes at a time when SDOH innovation is still finding its legs is fraught with potential shortcomings or missteps. We’ll save that commentary for elsewhere — the remainder of this article is dedicated to serving as a resource for any parties interested in submitting a comment in support of or amendment to the proposed codes.

We reviewed the proposed codes from the CDC’s National Center for Health Statistics and organized them into the below table. The ICD-10’s Coordination and Maintenance Committee is in charge of reviewing all public comments, which need to be sent by May 10, 2019 to the Committee’s e-mail address.

note: Yellow shading indicates the newly proposed z-codes

A Few Notes:

  • We were pleasantly surprised to learn that the headlines and retweets missed the full story: There were actually two proposals for expanding Z-Codes: One from UHC and AMA, and another from a team led by BCBS of Vermont and the Yale School of Nursing. The latter focused on codes related to Food Insecurity across Categories Z59, Z71, and Z91. We’ve put them together and organized by code in the table above.
  • If you’re wondering what to comment on, anything is fair game. Which codes are a good idea to move forward with? Which should be dropped? Are there certain proposed items that belong in other code sets or standards? That being said, the Committee will not accept any new proposals submitted during this comment period (that will have to wait until the September 2019 meeting)
  • Comments will be reviewed in May and final decisions will be made in June/July. It’s worth noting that any new codes that are accepted will not go into effect until October 2020.
  • We will continue exploring these new codes in the weeks ahead to analyze new use cases they may enable, potential problems they may introduce, and everything in between. If you have questions or comments you would like to share with us please send us a note: hello@patchwiselabs.com