www.mercycareplan.com                                  www.mercymaricopa.org
February 9, 2018
Use of social determinants of health codes for member outcomes update
As part of AHCCCS', as well as Mercy Care's, efforts in developing a streamlined method of collecting and tracking member outcomes, the use of specific ICD-10 diagnosis codes representing Social Determinants of Health has been identified as a valuable source of information that impacts member health.
The Social Determinants of Health codes identify the conditions in which people are born, grow, live, work, and age. They include factors like:
  • Education
  • Employment
  • Physical environment
  • Socioeconomic status
  • Social support networks
As appropriate within their scope of practice, providers should be routinely screening for, and documenting, the presence of social determinants. Any identified social determinant ICD-10 diagnosis codes should be provided on all claims for AHCCCS members in order to comply with state and federal coding requirements. Beginning with dates of service on and after April 1, 2018, Mercy Care, in accordance with AHCCCS will begin to monitor claims for the presence of these codes.
As of October 1, 2017, the following ICD-10 diagnosis codes are defined as Social Determinants of Health codes under ICD-10. Please note that Social Determinants of Health codes may be added or updated on a quarterly basis. Providers should remain current in their thorough utilization of these codes.
The below listed ICD-10 Social Determinant codes should not be billed as the primary or only diagnosis code, as those claims will be denied for an appropriate primary diagnosis code.  The Social Determinant ICD-10 code should be appended to claims where you are seeing a member for another primary condition and service covered by the plan. 

ICD-Code Description
Z55.0 Illiteracy and low-level literacy
Z55.1 Schooling unavailable and unattainable
Z55.2 Failed school examinations
Z55.3 Underachievement in school
Z55.4 Educational maladjustment and discord with teachers and classmates
Z55.8 Other problems related to education and literacy
Z55.9 Problems related to education and literacy, unspecified
Z56.0 Unemployment, unspecified
Z56.1 Change of job
Z56.2 Threat of job loss
Z56.3 Stressful work schedule
Z56.4 Discord with boss and workmates
Z56.5 Uncongenial work environment
Z56.6 Other physical and mental strain related to work
Z56.81 Sexual harassment on the job
Z56.82 Military deployment status
Z56.89 Other problems related to employment
Z56.9 Unspecified problems related to employment
Z57.0 Occupational exposure to noise
Z57.1 Occupational exposure to radiation
Z57.2 Occupational exposure to dust
Z57.31 Occupational exposure to environmental tobacco smoke
Z57.39 Occupational exposure to other air contaminants
Z57.4 Occupational exposure to toxic agents in agriculture
Z57.5 Occupational exposure to toxic agents in other industries
Z57.6 Occupational exposure to extreme temperature
Z57.7 Occupational exposure to vibration
Z57.8 Occupational exposure to other risk factors
Z57.9 Occupational exposure to unspecified risk factor
Z59.0 Homelessness
Z59.1 Inadequate housing
Z59.2 Discord with neighbors, lodgers and landlord
Z59.3 Problems related to living in residential institution
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
Z59.8 Other problems related to housing and economic circumstances
Z59.9 Problem related to housing and economic circumstances, unspecified
Z60.0 Problems of adjustment to life-cycle transitions
Z60.2 Problems related to living alone
Z60.3 Acculturation difficulty
Z60.4 Social exclusion and rejection
Z60.5 Target of (perceived) adverse discrimination and persecution
Z60.8 Other problems related to social environment
Z60.9 Problem related to social environment, unspecified
Z62.0 Inadequate parental supervision and control
Z62.1 Parental overprotection
Z62.21 Child in welfare custody
Z62.22 Institutional upbringing
Z62.29 Other upbringing away from parents
Z62.3 Hostility towards and scapegoating of child
Z62.6 Inappropriate (excessive) parental pressure
Z62.810 Personal history of physical and sexual abuse in childhood
Z62.811 Personal history of psychological abuse in childhood
Z62.812 Personal history of neglect in childhood
Z62.819 Personal history of unspecified abuse in childhood
Z62.820 Parent-biological child conflict
Z62.821 Parent-adopted child conflict
Z62.822 Parent-foster child conflict
Z62.890 Parent-child estrangement NEC
Z62.891 Sibling rivalry
Z62.898 Other specified problems related to upbringing
Z62.9 Problem related to upbringing, unspecified
Z63.0 Problems in relationship with spouse or partner
Z63.1 Problems in relationship with in-laws
Z63.31 Absence of family member due to military deployment
Z63.32 Other absence of family member
Z63.4 Disappearance and death of family member
Z63.5 Disruption of family by separation and divorce
Z63.6 Dependent relative needing care at home
Z63.71 Stress on family due to return of family member from military deployment
Z63.72 Alcoholism and drug addiction in family
Z63.79 Other stressful life events affecting family and household
Z63.8 Other specified problems related to primary support group
Z63.9 Problem related to primary support group, unspecified
Z64.0 Problems related to unwanted pregnancy
Z64.1 Problems related to multiparity
Z64.4 Discord with counselors
Z65.0 Conviction in civil and criminal proceedings without imprisonment
Z65.1 Imprisonment and other incarceration
Z65.2 Problems related to release from prison
Z65.3 Problems related to other legal circumstances
Z65.4 Victim of crime and terrorism
Z65.5 Exposure to disaster, war and other hostilities
Z65.8 Other specified problems related to psychosocial circumstances
Z65.9 Problem related to unspecified psychosocial circumstances
Z71.41 Alcohol abuse counseling and surveillance of alcoholic
Z71.42 Counseling for family member of alcoholic
Z71.51 Drug abuse counseling and surveillance of drug abuser
Z71.52 Counseling for family member of drug abuser
Z72.810 Child and adolescent antisocial behavior
Z72.811 Adult antisocial behavior
Z72.89 Other problems related to lifestyle
Z72.9 Problem related to lifestyle, unspecified
Z73.0 Burn-out
Z73.1 Type A behavior pattern
Z73.2 Lack of relaxation and leisure
Z73.3 Stress, not elsewhere classified
Z73.4 Inadequate social skills, not elsewhere classified
Z73.89 Other problems related to life management difficulty
Z73.9 Problem related to life management difficulty, unspecified

  • As always, don't hesitate to contact your Mercy Care  or your Mercy Maricopa Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care Plan or Mercy Maricopa website.   

    Thanks for all you do!

    QB 3219

  • www.mercycareplan.com                        www.mercymaricopa.org