Social determinants of health (SDOH), also referred to as social drivers of health, are the conditions in the environments where people are born, live, learn, work, play, worship, and age. These conditions affect a wide range of health, functioning, and quality of life outcomes and risks. (Healthy People 2030)
The majority (80%) of a person’s health and well-being is related to an individual’s social determinants, physical environment and behavioral factors while the other 20 percent is related to access to care and quality of services. (American Hospital Association – Addressing Social Determinants of Health, 2018).
Understanding the social determinants of the individuals served at your organization will help you provide better care and the opportunity to set those individuals up for success when they are back home.
American Hospital Association
To best understand what SDOH are impacting those you serve this information must be collected and stored in a way that it can be easily accessed and analyzed.
One way to capture standardized information on SDOH is by using Z codes, which are a set of ICD-10 codes. There is a set of Z codes specific to SDOH (i.e.Z55-Z65) that 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.¹
For additional detail, access this Social Determinants of Health Data with ICD-10 CM Z Codes, developed by CMS.
Z codes can be used in all health settings (e.g., doctor’s office, hospital, skilled nursing facility (SNF) and by all providers (e.g., physician, nurse practitioner).
Utilization in North Dakota and South Dakota
When looking at North Dakota and South Dakota Medicare FFS beneficiaries who were seen by a provider in North Dakota or South Dakota from April 1, 2023, to March 31, 2024, there were:
|
28,034 Part A or B claims with at least one Z code included |
| 4,362 distinct Medicare FFS beneficiaries with a Z Code claim 2% of total distinct Medicare FFS beneficiaries with any Part A/B claim |
Overall, in North Dakota and South Dakota, Z codes are being utilized, but are seen in a small amount of total Part A or B claims (.53%) and among a small percentage of FFS beneficiaries (2%).
For North Dakota and South Dakota Medicare FFS beneficiaries seen by a North Dakota or South Dakota provider during the above timeframe, claims including at least one Z code were most often Medicare Part A claims (75%). There were 21,070 Part A, and 6,964 Part B claims with Z codes.
Proportion of ND and SD Medicare FFS Z Code Claims by Type
04/01/2023 – 03/31/2024
Among all Z code claims (0.53% of all Part A or Part B claims) that were collected, we are seeing it across multiple facility types and multiple provider types. Z codes are a tool that can be used in all health settings and by all providers.
The five Z codes that represented the largest shares of all Medicare FFS beneficiaries with a Z code claim (N=4,362) during April 1, 2023-March 31,2024 were:
| Z code | Description | n | Proportion of Beneficiaries with a Z code claim |
| Z59.3 | Problems related to living in a residential institution | 1282 | 21% |
| Z63.4 | Disappearance and death of a family member | 697 | 11% |
| Z59.0 | Homelessness | 296 | 5% |
| Z60.2 | Problems related to living alone | 294 | 5% |
| Z63.79 | Other stressful life events affecting family and household | 281 | 5% |
By identifying these SDOH factors of health and addressing them, we work toward achieving health equity and ensuring the highest quality and best-value care for all beneficiaries. Are Z codes being captured at your organization? If so, is this information being utilized to identify and address health disparities, improve care coordination and referrals, identify community and population needs and policy development?
Getting Started
Using Z Codes: The Social Determinants of Health Data Journey to Better Outcomes
