Z Codes
Medical Billing
Coding for Social Determinants of Health: The Power of Z Codes
Bridging the Gap Between Clinical Care and Community Support
While most ICD-10 codes describe an illness, Z codes document the "why" behind a patient's health status. At CCHP, these codes are the primary signal our Community Health Navigators and Case Managers use to identify members who need extra help with housing, food, or employment.
Provider Impact: When you include Z codes on your claims, you aren't just billing; you are triggering a support system that helps your patient stay healthy outside of the exam room.
Key Z Code Categories for CCHP Members
Use the tables below to quickly identify the correct codes for Social Determinants of Health (SDOH).
Alcohol & Drug Counseling (Z71)
Note: Use these for counseling and surveillance of the patient or their family.
Z7141 Alcohol abuse counseling and surveillance of alcoholic
Z7142 Counseling for family member of alcoholic
Z7151 Drug abuse counseling and surveillance of drug abuser
Z7152 Counseling for family member of drug abuser
Employment & Workplace Stress (Z56)
Z56.0 Unemployment, unspecified
Z56.2 Threat of job loss
Z56.3 Stressful work schedule
Z56.81 Sexual harassment on the job
Education & Literacy (Z55)
Z55.0 Illiteracy and low-level literacy
Z55.3 Underachievement in school
Z55.4 Educational maladjustment (discord with teachers/classmates)
Housing & Economic Circumstances (Z59)
Crucial for identifying members facing housing instability or food insecurity
Z59.0 Homelessness (Shelter, street, or transitional housing)
Z59.1 Inadequate housing (Lack of heat, water, or safety)
Z59.4 Lack of adequate food and safe drinking water
Z59.5 Extreme poverty
Z59.6 Low income
Z59.7 Insufficient social insurance and welfare support
Body Mass Index (BMI) Coding (Z68)
BMI Z codes provide context for nutritional and obesity-related health risks.
Z68.41 BMI 40.0–44.9
Z68.42 BMI 45.0–49.9
Z68.43 BMI 50.0–59.9
Z68.45 BMI 70 or greater
Z68.51 < 5th percentile for age
Z68.52 5th to < 85th percentile
Z68.53 85th to < 95th percentile
Z68.54 ≥ 95th percentile for age
Best Practices for Providers
1. Z Codes as Secondary: Z codes are usually reported as secondary diagnoses. Always list the primary medical reason for the visit first.
2. Document the Conversation: Ensure the patient's medical record reflects the social factor identified (e.g., a note regarding the patient’s struggle with transportation or housing).
3. No "Official" Diagnosis Needed: Many SDOH Z codes can be reported based on patient self-reporting or documentation by non-physician clinicians (like social workers or nurses).
Need to Refer a Member Directly?
If you have a member who needs immediate assistance from the CCHP Care Management and Social Navigation Team, please contact our team directly by email at healthpromotion@chorushealthplans.org or complete our online Care Management & Health Promotion Referral Form linked below.