CMS Reports on Rates of Social Determinants of Health Coding on FFS Claims in 2017

CMS began collecting data on social determinants of health (SDOH) through the use of z-codes in 2016. The agency reported that among 33.7 million total Medicare FFS beneficiaries in 2017, approximately 1.4% had claims with Z codes. SDOH indicators are widely recognized as important predictors in clinical care and positive conditions are associated with improved patient outcomes and reduced costs.

The 5 most utilized Z codes in 2017 from Medicare FFS claims were:

  • Z590 – Homelessness
  • Z602 – Problems related to living alone
  • Z634 – Disappearance and death of family member
  • Z658 – Other specified problems related to psychosocial circumstances
  • Z630 – Problems in relationship with spouse or partner

Of the 467,136 Medicare FFS beneficiaries with Z code claims, 334,373 individuals (72%) had hypertension and 248,726 individuals (53%) had depression.

Z codes did not exist prior to the implementation of the ICD-10-CM codes in 2015. Their precursors in ICD-9 were V codes.

 

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For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at 202-204-1459 or smadhani@mcdermottplus.com.