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Appendix YA
I American Hospital Association"'
Advancing Health in America
ICD-10-CM Coding for Social Determinants of Health
Introduction In the past decade, there has been a growing interest in the social determinants of health. Social determinants include societal and environmental conditions such as food, housing, transportation, education, violence, social support, health behaviors and employment. Numerous studies have demonstrated a link between economic status, social factors and physical environment as key influencers in health outcomes.
Data Collection Challenges Understanding data related to social determinants of health - including educational level, employment, or problems related to home and work environments - is critical as hospitals and health systems work to improve the health of their communities. Currently, hospitals and health systems may capture many of these social factors by utilizing the ICD-10-CM codes included in categories Z55-Z65, which identify persons with potential health hazards related to socioeconomic and psychosocial circumstances.
Despite the availability of these ICD-10-CM codes, however, recent studies show that they have been infrequently utilized in inpatient settings for discharges other than those related to mental health and alcohol/substance use. In addition, another study noted that an "obvious discrepancy exists between the number of identifiable social factors, a provider's ability to address them and documentation with billing and diagnosis codes:'
One reason for this is that, based on the ICD-10- CM Official Guidelines for Coding and Reporting, coding professionals were not able to report these codes unless they were supported by physician documentation. As a result, most hospitals and health systems are unable to report these codes because societal and environmental conditions are routinely documented and addressed by non- physician providers, such as case managers, discharge planners, social workers and nurses.
What New The AHA has worked to change this requirement to promote widespread use of these ICD-10-CM codes. As a result of these efforts, in early 2018, the AHA Coding Clinic published advice that allows the reporting of codes from categories Z55-Z65, based on information documented by all clinicians involved in the care of the patient. This advice was approved by the ICD-10-CM Cooperating Parties and will be incorporated into the next revision of the Official Coding Guidelines. This change is effective beginning Feb. 18, 2018.
What You Can Do G» Hospitals and health systems should
educate necessary individuals, including physicians, non-physician health care providers, and coding professionals of the important need to collect data on the social determinants of health. Utilizing these codes will allow hospitals and health systems to better track patient needs and identify solutions to improve the health of their communities.
As coding professionals review a patient's medical record to identify the appropriate ICD-10-CM codes to include, they should be aware of and begin utilizing the ICD-10-CM codes included in categories Z55-Z65, listed in Table 1.
Additional Information For more information, contact Nelly Leon-Chisen, AHIA, AHA director of coding and classification, at [email protected].
The AHA has developed numerous tools and resources to help hospitals and health systems address the social determinants of health in their communities. For access to these resources, please visit www.aha.org .
©2018American Hospital Association I April 2018 American Hospital Association
I American Hospital Association'"
Advancing Health in America
Table 1 ICD-10-CM Code Categories
ICD-10-CM Code Category
Z55 - Problems related to education and literacy
Z56 - Problems related to employment and unemployment
Z57 - Occupational exposure to risk factors
Z59 - Problems related to housing and economic circumstances
Z60 - Problems related to social environment
Z62 - Problems related to upbringing
Z63 - Other problems related to primary support group, including family circumstances
Z64 - Problems related to certain psychosocial circumstances
Z65 - Problems related to other psychosocial circumstances
Problems/Risk Factors Included in Category
Illiteracy, schooling unavailable, underachievement in a school, educational maladjustment and discord with teachers and classmates.
Unemployment, change of job, threat of job loss, stressful work schedule, discord with boss and workmates, uncongenial work environment, sexual harassment on the job, and military deployment status.
Occupational exposure to noise, radiation, dust, environmental tobacco smoke, toxic agents in agriculture, toxic agents in other industries, extreme temperature, and vibration .
Homelessness, inadequate housing, discord with neighbors, lodgers and landlord, problems related to living in residential institutions, lack of adequate food and safe drinking water, extreme poverty, low income, insufficient social insurance and welfare support.
Adjustment to life-cycle transitions, living alone, acculturation difficulty, social exclusion and rejection, target of adverse discrimination and persecution.
Inadequate parental supervision and control, parental overprotection, upbringing away from parents, child in welfare custody, institutional upbringing, hostility towards and scapegoating of child, inappropriate excessive parental pressure, personal history of abuse in childhood, personal history of neglect in childhood, 262.819 Personal history of unspecified abuse in childhood, Parent-child conflict, and sibling rivalry.
Absence of family member, disappearance and death of family member, disruption of family by separation and divorce, dependent relative needing care at home, stressful life events affecting family and household, stress on family due to return of family member from military deployment, alcoholism and drug addiction in family.
Unwanted pregnancy, multiparity, and discord with counselors.
Conviction in civil and criminal proceedings without imprisonment, imprisonment and other incarceration, release from prison, other legal circumstances, victim of crime and terrorism, and exposure to disaster, war and other hostilities.
©2018American Hospital Association I April 2018 American Hospital Association www.aha.org ------ Advancing Health in America
© Oregon Primary Care Association
APPENDIX YC SDOH in clinic setting Oregon Primary Care Association
Social Determinant of Health (SDH) ICD-10 Z Codes As healthcare moves toward payment for outcomes rather than volume, health centers will increasingly have business and impact-related rationale for collecting and acting on social determinants of health (SDH). Standardized medical vocabulary like ICD-1Oz-codes or LOINC could offer a way to aggregate and analyze SDH data across health centers, providers, and payers. This tool outlines existing ICD-10 z-codes that are a close match to social needs responses identified through use of the PRAPARE tool. Linking standardized and commonly used medical codes to social domains, will allow health centers to use such structured data for improved treatment plan development, community resource connecting, and to build the beginning of a robust SDH dataset across health center populations for policy and evaluation.
Please note that not all PRAPARE questions have relevant z-codes. For example refugee status, Race, Latino or Hispanic, or Migrant Farmworker.
PRAPARE PRAPARE Plus in OCHIN EPIC
Education, Literacy & Language SDH Questions SDHResponses Intervention Ideas and Community Resources ICD-10 Z Codes
What language are you most • English comfortable speaking? • Language other than
English • I choose not to answer
this auestion What is the highest level of • Less than a high school that you have school diploma finished? • High school diploma
/GED • More than high school • I choose not to answer
this auestion How do you learn best? • Reading
• Listening • Picture
Clinical Level - Develop dedicated services for medical interpretation that include
in-person or telephonic qualified interpreters and medical documents and medication instructions in preferred language.
- Recruit and hire culturally and linguistically competent providers/personnel and continuously train on communication and cultural competency.
- Use "teach-back"to ensure patient understanding. - Ensure prescriptions and treatment instructions match patient's
literacy level. - Use visual aids like colored caps for pill containers or calendars
to convey which medication need to be taken. Non-Clinical Level - Conduct monthly free health literacy classes in order to better
prepare individuals when going into clinical settings. - Offer or refer patient to courses for English language, math,
reading, financial literacy, computer skills, etc. - Promote early childhood development and school readiness, pre-
school/Head Start, offer tutorina or homework assistance for
255.0 Illiteracy and low- level literacy
255.1 Schooling unavailable or unattainable
255.2 Failed school examinations
255.3 Underachievement in school
255.4 Educational maladjustment and discord with teachers and classmates
© Oregon Primary Care Association
333 SW 5'h Ave • Suite 250 • Portland OR 97204 • 503.228 . 8852 office • 503 .228 .988 7 fax • www.orpca.org
© Oregon Primary Care Association
children or offer Read Out Loud program to increase children's literacy.
- Prepare for GEDs, citizenship tests, and post-secondary education.
Community Level - Establish or operate charter schools - Provide college grants/scholarships
255.8 Other problems related to education and literacy
255.9 Problems related to education and literacy, unspecified
260.3 Acculturation difficulty
Economic Hardships (Resources & Materials) SDH Questions SDHResponses Intervention Ideas and Community Resources ICD-10 Z Codes
Inthe past year, have you or • Food • Utilities • Medicine or any health
care • Phone • Clothing • Childcare • Other
Clinical Level - Provide list of social services in preferred language listing
programs offered at organizations, state and federal levels. - To address patients without health care coverage, offer a sliding
scale fee payment method or see if patient's sliding fee scale should be adjusted
- Have an ACA enrollment agent/assister on-site to enroll for Medicaid, CHIP, and Medicare or Marketplace eligibility.
- Prescribe generic versions of medications offered through discounted drug pricing programs (3408) or other free or low-cost prescription programs.
- Integrate community health care workers into primary care team to better inform patients of available resources available while they visit the clinic.
- Integrate social services into care plan when seeing a patient in order to establish a comprehensive care treatment plan for patients challenged with an insurance barrier.
- Offer and promote mobile clinic services, to partner organizations like churches or schools to increase mobile health care access and utilization.
Non-Clinical Level - Connect patients to community resources and social services
offered by state governments, federal programs, charities, and private companies
259 Problems related to any family members you live housing and economic with been unable to get any circumstances of the following when it was really needed? 259.4 Lack of adequate
food and safe drinking water
259.5 Extreme poverty (100% FPL or below) How hard is it for you to pay for the very basics like food, housing, heating, medical care, and medication?
• Not hard at all • Somewhat hard
• Very Hard
259.6 Low income (200% FPL or below)
259.7 Insufficient social Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?
• Yes, it has kept me from medical appointments or from getting my medications
• Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need
insurance and welfare support
291.120 Patient's intentional under dosing of medication regimen due to financial hardship
333 SW 5'" Ave • Suite 250 • Portland OR 97204 • 503.228 .8852 office • 503 .228.9887 fax • www.orpca.org
333 SW S'h Ave • Suite 250 • Portland OR 97204 • 503 . 228 .8852 office • 503 .228 .9887 fax • www.orpca.org © Oregon Primary Care Association
• No • I choose not to answer
this question
- Collect gently used goods such as clothing, furniture, work uniforms, toys, school, and interview clothes to offer to patients. Alternatively, refer patients to local food banks or thrift stores.
- Provide classes to educate individuals on basic living, job training, and budgeting skills to enable them to help themselves.
Community Level - Initiate a dialogue about promoting civic involvement, economic
development, workforce development, and leadership training, which may lead to developing and supporting coalitions to address economic challenges in community.
- Centralize and integrate the strategic collection of health and economic data across project partners.
- Create an economic community development organization that organizes job fairs, workshops, and assistance with financial resource strain.
What is your main insurance? • None/uninsured • Medicaid • Medicare • CHIP Medicaid • Other public health
insurance (not CHIP) • Other public health
insurance (CHIP) • Private Insurance
'
Do you have insurance through your job?
• Yes • No
Housing Security SDH Questions SDHResponses Intervention Ideas and Community Resources ICD-10 Z Codes
What is your housing • I have housing • I do not have housing • I choose not to answer
this question
Clinical Level - Avoid prescriptions of medications that require refrigeration
where refrigeration is lacking - Conduct home visits among seniors to check and remove causes
for potential falls and other types of injuries while ensuring high quality of life
Non-Clinical Level - Refer patients to medical respite care services to recover from
acute illnesses or injuries in a safe environment with access to
259 Problems related to situation today? housing and economic
circumstances
259.0 Homelessness Are you worried about losing your housing?
• Yes • No • I choose not to answer
this question 259.1 Inadequate housing
What address do you live at? Open ended question.
333 SW S'h Ave • Suite 250 • Portland OR 97204 • 503 . 228 .8852 office • 503 .228 .9887 fax • www.orpca.org © Oregon Primary Care Association
In the last month: Have you slept outside, in a shelter, or in a place not
• Yes • No
care and supportive services outside the hospital and off the streets.
- Help patients navigate housing market in the area through referral, information, financial counseling, and classes for first- time buyers.
- Create Medical Legal partnerships to advocate for patient with unsafe and unaffordable homes.
Community Level - Develop informational resources for agents, builders, developers,
and lenders of needs of special populations to consider when building or leasing buildings.
- Organize community donation day to ensure local shelter is well stocked with essentials: shampoo, toothpaste, toothbrushes, sanitary napkins, winter and interview clothing, blankets, pillows, etc.
- Centralize and integrate the strategic collection of health and housing data across project partners. Use data to create and implement new referral systems between agencies.
- Create a housing and community development organization that organizes housing fairs, workshops, and assistance with the purchase of a home, tenant services, and assistance in improvements for income-eligible homeowners and landlords.
- Participate in community-wide coordinated entry systems, such as the HUD-funded Continuum of Care, to provide fair and equal access to affordable housing, whether transitional housing, shelter services, supportive housing, or affordable assisted living residences.
- Convene discussions on gentrification policies and how and where to build affordable and safe housing with access to resources to live healthy lives (healthy foods, parks, gyms, etc.)
- Work with other organizations (Habitat for Humanity, etc.) to build or renovate homes for those in need.
259.2 Discord with neighbors, lodgers and landlord
meant for sleeping? 259.5 Extreme poverty In the last 12 months, how many times have you moved from one home to another?
Open ended question. (100% FPL or below)
259.6 Low income (200% FPL or below)
259.8 Other problems related to housing and economic circumstances
259.9 Problem related to housing and economic circumstances, unspecified
Employment SDH Questions SDH Responses Intervention Ideas and Community Resources ICD-10 Z Codes
Have you been discharged from the armed forces of the United States?
• Yes • No • I choose not to answer
Clinical Level - Continuously inquire about patient's employment situation and
type of employment beyond the initial new patient form.
256 Problems related to employmenU unemployment
256.0 Unemploy ment this question
333 SW 5th Ave • Suite 250 • Portland OR 97204 • 503.228.8852 office • 503.228.9887 fax • www.orpca.org © Oregon Primary Care Association
What is your current work? • Unemployed and seeking work
• Part-time or temporary work
• Full-time work • Otherwise
unemployed but not seeking work
- For patients who report fair or poor health, ask if there are any health and social services that they think or feel they need and coordinate link to services requested.
- Screen for mental health disorders and provide appropriate treatment.
Non-Clinical Level - Refer patients to temp agencies for temporary work, employment
centers for assistance with resume building and interviewing practice, community colleges to further education or to acquire new marketable skills.
- Offer SNAPfTANF enrollment and unemployment compensation process assistance if loss of income is a result of loss of employment.
Community Level - Encourage community business development involving
community members to encourage local hiring practices. - Organize job fair with representatives from both local and
communitv-servinQ businesses
256.82 Military deployment status
256.9 Unspecified problems related to employment
259.5 Extreme poverty (100% FPL or below)
259.6 Low income (200% FPL or below)
Food Security SDH Questions SDH Responses Intervention Techniques and Community Resources ICD-10 Z Codes
In the last 12 months: (I/we) worried whether (my/our) food would run out before (I/we) got money to
• Often true • Sometimes true • Never true
Clinical Level - Refer patients to food pantry (either in-house or through
partnership) so they can access free foods.
- Check to see if patient is eligible for food programs and benefits, such as WIC (Women, Infant, and Children Food Nutrition Service), SNAP (Supplemental Nutrition Assistance Program), etc.
- Ensure children are enrolled in free or reduced breakfast and lunch at school.
Non-Clinical Level - Start a food pantry filled with donated foods. Hold donation drives
throughout the year requesting certain foods if pantry is lacking in specific food groups.
- Build a community garden with classes or other educational opportunities to teach patients and community about food, nutrition, and healthy cooking and eating. Grow foods used in cultures present in your patient population.
259.4 Lack of adequate food and safe drinking water
buy more. 259.5 Extreme Poverty (100% FPL or below)
In the last 12 months: The food that (I/we) bought just didn't last, and (I/we) didn't have money to get more.
• Often true • Sometimes true • Never true
259.6 Low income (200% FPL or below)
272.4 Inappropriate diet and eating habits
In the last 12 months: (I/we) couldn't afford to eat balanced meals.
• Often true • Sometimes true • Never true
333 SW 5th Ave • Suite 250 • Portland OR 97204 • 503.228.8852 office • 503.228.9887 fax • www.orpca.org © Oregon Primary Care Association
Physical Health (Exercise) SDH Questions SDHResponses Intervention Techniques and Community Resources ICD-10 Z Codes
On average, how many: Open ended question. Clinical Level - Provide a list of recreation centers offering free or low-cost sports
classes; provide a list of nearby hiking trails or parks as alternatives to unsafe parks
Non-Clinical Level - Offer/find community volunteer to lead exercise and wellness
classes at the health center such as yoga, Zumba, aerobics, etc. - Conduct Community Level - Partner with local health and wellness facilities to offer open gym
times for community members of your clinic - Organize community running or walking clubs, softball teams,
soccer team, and etc.
- Work with community partners, policy makers, and funders to develop a community park.
272.3 Lack of physical Days per week do you exercise engage in moderate to strenuous exercise?
259.5 Extreme poverty
(100% FPL or below) Minutes do you exercise at this level?
259.6 Low income (200%
FPL or below)
333 SW 5th Ave • Suite 250 • Portland OR 97204 • 503.228.8852 office • 503.228.9887 fax • www.orpca.org © Oregon Primary Care Association
Social & Emotional Health SDH Questions SDHResponses Intervention Techniques and Community Resources ICD-10 Z Codes
How often do you see or talk • Less than once a week
• 1 or 2 times a week • 3 to 5 times a week • More than 5 times a
week • I choose not to
answer this question
Clinical Level - Engage new patients who come into the clinic by asking if they
just moved to the area, why they came to the new facility, etc. Then take note of what you hear that you can relate to and provide information on places that may be of interest to patient.
- Host community events on or near healthcare facility to actively be inclusive of community members and open up a door for current patients who may be having trouble socially.
- Leave flyers and posters about all-inclusive community group events in and around the clinical setting for patients to easily access and learn more.
Non-Clinical Level - Work with community organizations in order to increase
awareness of their presence as well as what resources they can provide.
- Be intentional about inclusion of full community when creating and hosting local.
- Host peer support groups. Community Level - Initiate a dialogue about promoting civic involvement, economic
development, workforce development, and leadership training, which may lead to developing and supporting coalitions to address economic challenges in community.
- Collaborate with other health centers to provide community space for workshops and developmental clinics on health and wellness.
- Have 'town hall meetings' (if they do not presently exist) for individuals in the neighborhood to be able to come together in order to discuss their thoughts about their environment.
- Actively engage community members on a consistent basis focusing on high priority needs as determined by the community.
- Coordinate volunteer days for patients at local shelter, food pantries, and other community partner organization
260 Problems related to people that you care about social environment and feel close to?
260.0 Problems of adjustment to life-cycle transitions
260.2 Problems related to living alone
260.3 Acculturation difficulty
Are you married or living together with someone in a partnershio?
260.4 Social exclusion and rejection
In a typical week, how often do you: Talk with family, friends, or neighbors by phone or video chat Get together with family, friends, or neighbors? Use email, text messaging, or internet to communicate with family, friends, or neighbor?
260.5 Target of (perceived) adverse discrimination/persecutio n
260.8 Other problems related social environment
262 Problems related to upbringing
262.2 Upbringing away How often do you: Attend church or religious services? Attend meetings of the clubs or organizations you belong to?
from parents
262.22 Institutional upbringing
263 Other problems related to primary support
How often do you feel lonely or isolated from those around you?
group, including family circumstances
333 SW 5'" Ave • Suite 250 • Portland OR 97204 • 503.228.8852 office • 503 .228.9887 fax • www.orpca.org © Oregon Primary Care Association
Mental Health & Stress SDH Questions SDHResponses Intervention Ideas and Community Resources ICD-10 Z Codes
Stress is when someone feels • Not at all • A little bit • Somewhat • Quite a bit • Very much • I choose not to
answer this question
Clinical Level - Be proactive in helping the patient identify where the stressors
are coming from. - Work with patient to draw links between the stressors and
resources to help alleviate them - Provide patient with healthy stress management alternatives to
medication such as exercising, yoga, meditation, etc. - Directly address physical manifestations of patient identified
stressors - Help patient identify calming activities they enjoy and routinely
work into their lives to alleviate stressors. - Screen for PTSD, suicide ideation, and alcohol and substance
abuse; offer or refer to clinical psychologists and peer-support groups; provide or link them to a case manager.
Non-Clinical Level - Connect individuals with healthy outlets to reduce stress such as
community gardens, low-cost yoga studios, parks & walking trails, etc.
- Work with the individual to connect them with social groups that appeal to their interests
- Provide education on ways one can reduce stress and bad habits associated with stress.
- Connect individuals to counseling services to help reduce adverse health factors associated with stress
Community Level - Develop a community organizing campaign to keep the
neighborhood safe such as: working together to create a safe atmosphere can in turn provide less anxiety or stress concerning personal safety for individuals in the community
- Establish a firm network of social and psychological communal support through community organizing and deliberate interaction with neighbors and local officials
- Advocate for the growth & maintenance of more parks and open space in your neighborhoods
- Starting wellness initiatives (Free yoga in the park on Saturdays, communitv hikina/walkina trios, etc.)
256 Problems related to tense, nervous, anxious, or employment and can't sleep at night because unemployment their mind is troubled. How stressed are you? 256.1 Change of job
256.2 Threat of job loss
256.3 Stressful work schedule During the past month, how much stress would you say you experienced?
• A lot of stress • A moderate amount
of stress • Relatively little stress • Almost no stress at
all
256.4 Discord with boss and workmates
256.6 Other physical and mental strain related to work
256.89 Other problems related to employ
264 Problems related to certain psychosocial circumstances
265 Problems related to other psychosocial circumstances
273 Problems related to life management difficulty
273.3 Stress, not elsewhere classified
333 SW S'h Ave • Suite 250 • Portland OR 97204 • 503.228.8852 office • 503.228.9887 fax • www.orpca.org © Oregon Primary Care Association
Safety & Domestic Violence SDH Questions SDH Responses Intervention Ideas and Community Resources ICD-10 Z Codes
Do you feel physically and emotionally safe where you currently live?
In the past year, have you been afraid of your partner or ex- partner?
Have you ever been physically or emotionally hurt or threatened by a spouse/ partner or someone else you know?
• Yes • No • Unsure
• Yes • No • Unsure • I have not had a
partner in the past year
• I choose not to answer this question
• Yes • No
Clinical Level: - Train physicians/health care providers to be able to identify the
early indicators of abuse within a clinical visit. Refer to behavioral health services if necessary.
- Create an atmosphere of safety for the patient being seen (i.e. "patient-only" signs beyond a certain point in the office). If partner attends clinic visit with patient, ask partner to leave for part of the visit to discuss private matters, but do not mention it is for domestic violence screening.
- Display educational posters and flyers about domestic violence in and around the clinic to help create a safe, welcoming, and empowering environment.
- Develop partnerships with local shelters and housing organizations for victims of domestic violence.
- Have staff trained in assessment and screening for domestic violence victims, including their legal obligations for reporting such abuse.
Non-Clinical Level - Offer support groups for victims of domestic violence. - Establish a community referral system with ties to local
healthcare providers and other social services organizations.
260.4 Social exclusion and rejection
262.8 Other specified problems related to upbringing
262.81 Personal history of abuse in childhood
262.810 Personal history of physical and sexual abuse in childhood
262.811 Personal history of psychological abuse in childhood
262.812 Personal history of neglect in childhood
333 SW 5th Ave • Suite 250 • Portland OR 97204 • 503 .228 .88 52 office • 503.228 .9887 fax • www.orpca.org © Oregon Primary Care Association
- Organize neighborhood clean-up and beautification days- painting over gang-related graffiti with community designs, trash and recycling receptacle painting, park/beach clean-ups, etc.
Community Level - Work with local government officials to advocate for policies and
laws concerning domestic violence victims - Educate your community on the indicators of domestic violence
for all age groups. - If dealing with overcrowding at shelters, advocate building more
shelters. - Work with community groups (e.g., churches) to develop a
network of "safe houses" where victims of domestic violence can stay and receive support for a period if shelters are overcrowded.
- Develop a network of community leaders willing to take initiative when necessary for the betterment of the community.
- Charge community business owners and leaders to hold themselves accountable to learn, be trained in and recognize the signs, as well as how to take appropriate action.
262.819 Personal history of unspecified abuse in childhood
263 Other problems related to primary support group, includes family circumstances
263.9 Problems in relationship w/ spouse or partner
265.8 Other specified problems related to psychosocial circumstances
291.41 Personal history of adult abuse
291.410 Personal history of adult physical and sexual abuse
333 SW S'" Ave • Suite 250 • Portland OR 97204 • 503.228 .8852 office • 503 .228.9887 fax • www .orpca . org © Oregon Primary Care Association
In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?
• Yes • No • I choose not to answer If yes, what was your release date?
Clinical Level - Include medically necessary information in the electronic health
record and be mindful of the language used to avoid stigma and bias from other care team members
- Create a safe and nurturing space for all patients to reduce the social stigma. Normalize the experience of the patient and speak openly and nonjudgmentally.
Non-Clinical Level - Hire and train CHWs with a personal history of incarceration to
assist in case management support, navigation of medical care and local social services available to patient.
Community Level - Advocate for legislation to increase the number of job
opportunities for people with a criminal or incarceration history. - Advocate for a decrease in administrative or financial costs of
such as probation or parole fees.
*Resources in this section compiled from: http:// journalofethics.ama- assn.orgl2017 /09fecas2-1709.html and httos://www.ncbi.nlm.nih.aov/oubmed/22813476
265.0 Conviction in civil and criminal proceedings without imprisonment
265.1 Imprisonment and other incarcerations
Sources: This document was adapted from the Primary Care Social Detenninants of Health Survey Implementation Toolkit by Therese McIntyre, 2017 and the PRAPARE Toolkit by National Association of Community Health Center.
For a complete list of ICD-10 z codes visit http:f/www.icd10data.com/
1
APPENDIX YB List of ICD-10 Z codes for SDOH
ICD-10 Codes
ICD 10 code Descr iption IZ550 Illiteracy and low-level literacy Z551 )Chooling unavailable and unattainable Z552 Failed school examinations IZ553 Underachievement in school IZ554 Educational maladiustment and discord with teachers and IZ558 Other problems related to education and literacv 2559 Problems related to education and literacv unscecified IZ560 Unemployment, unspecified Z561 Change of iob IZ562 rThreat of iob loss 2563 Stressful work schedule Z564 Discord with boss and workmates IZ565 Uncongenial work environment IZ566 Other phvsical and mental strain related to work 25681 Sexual harassment on the iob 5682 Militarv deplovment status
Z5689 Other oroblems related to employment 2569 Unspecified problems related to employment Z570 Occupational exposure to noise !2571 Occupational exoosure to radiation IZ572 125731
Occupational exposure to dust Occuoational exposur e to environmental tobacco smoke
Z5739 Occupat ional exposure to other air contaminants IZ574 Occupational exposure to toxic agents in agriculture
Z575 Occupational exoosure to toxic agents in other industries IZ576 IZ577 IZ578 IZ579 IZ590 IZ591 IZ592
Occupational exposure to extreme temperature Occupational exposure to vibration Occupational exposure to other risk factors Occupational exposure to unspecified risk factor Homelessness Inadequate housing Discord with neighbors, lodgers and landlord
2593 Problems related to living in residential institution Z594 Z595 Z596 Z597 Z598 Z599 IZ6oo 2602 Z603
IZ604
2
Lack of adequate food and safe drinking water Extreme pover
ty Low income Insufficient social insurance and welfare support Other problems related to housing and economic circumstances Problem related to housing and economic circumstances, Problems of adjustment to life-cycle transitions Problems related to living alone Acculturation difficulty Social exclusion and rejection
3
APPENDIX YB List of ICD-10 Z codes for SDOH
Z605 rrarget of (perceived) adverse discrimination and persecution 2608 Othe r problems related to social environment Z609 Problem related to social environment, unspecified Z620 Inadequate parental supervision and control Z621 Par ental overprotection Z6221 Chil d in welfare custody Z6222 Instit ut ional upbringing Z6229 Ot her upbringing away from parents Z623 Host ilit y towards and scapegoating of child IZ626 Inappropriate (excessive) parental pressure IZ62810 Perso nal history of physical and sexual abuse in childhood IZ62811 Personal history of psychological abuse in childhood IZ62812 Pers onal history of neglect in childhood IZ62819 Personal history of unspecified abuse in childhood 1262820 Parent-biolog ical child conflict IZ62821 Parent-adopted child conflict IZ62822 Parent- foster child conflict Z62890 Parent -child estrangement NEC 262891 !Si bling rivalry 262898 Other specified problems related to upbringing 2629 Problem related to upbringing, unspecified 2630 Problems in relationship with spouse or partner Z631 Problems in relationship with in-laws Z6331 Absence of family member due to military deployment Z6332 Other absence of family member 2634 Disappearance and death of family member Z635 Disruption of family by separation and divorce 2636 Dependent relative needing care at home fZ6371 Stress on family due to return of family member from military Z6372 Alcoholism and drug addiction in family Z6379 Other stressful life events affecting family and household Z638 Other specified problems related to primary support group Z639 Problem related to primary support group, unspecified Z640 Problems related to unwanted pregnancy Z641 Problems related to multiparity Z644 Discord with counselors Z650 Conviction in civil and criminal proceedings without imprisonment Z651 Imprison ment and other incarceration Z652 Pro ble ms related to release from prison 2653 Problems related to other legal circumstances Z654 ! Victim of crime and terrorism Z655 Exposur e to disaster, war and other hostilities Z658 O t her specified problems related to psychosocial circumstances
4
APPENDIX YB List of ICD-10 Z codes for SDOH
2659 Problem related to unspecified psychosocial circumstances Z7141 Alcohol abuse counseling and surveillance of alcoholic IZ7142 Counseling for family member of alcoholic Z7151 Drug abuse counseling and surveillance of drug abuser IZ7152 Counseling for family member of drug abuser IZ72810 Child and adolescent antisocial behavior IZ72811 Adult antisocial behavior IZ7289 Other problems related to lifestyle 2729 Problem related to lifestyle, unspecified Z730 Burn-out 2731 !Type A behavior pattern Z732 Lack of relaxation and leisure Z733 Stress, not elsewhere classified Z734 Inadequate social skills, not elsewhere classified Z7389 Other problems related to life management difficulty Z739 Problem related to life management difficulty, unspecified
