Z55-Z65
Medium Complexity
Persons with potential health hazards related to socioeconomic and psychosocial circumstances
Primary Specialty: Social work
Last Updated: 2025-09-09
ICD-10 Codes (132)
127 billable0 category headers
Z56Z56.0Billable
Z56.1Billable
Z56.2Billable
Z56.3Billable
Z56.4Billable
Z56.5Billable
Z56.6Billable
Z56.8Billable
Z56.81Billable
Z56.82Billable
Z56.89Billable
Z56.9Billable
Z57Z57.0Billable
Z57.1Billable
Z57.2Billable
Z57.3Billable
Z57.31Billable
Z57.39Billable
Z57.4Billable
Z57.5Billable
Z57.6Billable
Z57.7Billable
Z57.8Billable
Z57.9Billable
Z58Billable
Z58.6Billable
Z58.8Billable
Z58.81Billable
Z58.89Billable
Z59Billable
Z59.0Billable
Z59.00Billable
Z59.01Billable
Z59.02Billable
Z59.1Billable
Z59.10Billable
Z59.11Billable
Z59.12Billable
Z59.19Billable
Z59.2Billable
Z59.3Billable
Z59.4Billable
Z59.41Billable
Z59.48Billable
Z59.5Billable
Z59.6Billable
Z59.7Billable
Z59.71Billable
Z59.72Billable
Z59.8Billable
Z59.81Billable
Z59.811Billable
Z59.812Billable
Z59.819Billable
Z59.82Billable
Z59.86Billable
Z59.87Billable
Z59.89Billable
Z59.9Billable
Z60Billable
Z60.0Billable
Z60.2Billable
Z60.3Billable
Z60.4Billable
Z60.5Billable
Z60.8Billable
Z60.9Billable
Z62Billable
Z62.0Billable
Z62.1Billable
Z62.2Billable
Z62.21Billable
Z62.22Billable
Z62.23Billable
Z62.24Billable
Z62.29Billable
Z62.3Billable
Z62.6Billable
Z62.8Billable
Z62.81Billable
Z62.810Billable
Z62.811Billable
Z62.812Billable
Z62.813Billable
Z62.814Billable
Z62.815Billable
Z62.819Billable
Z62.82Billable
Z62.820Billable
Z62.821Billable
Z62.822Billable
Z62.823Billable
Z62.83Billable
Z62.831Billable
Z62.832Billable
Z62.833Billable
Z62.89Billable
Z62.890Billable
Z62.891Billable
Z62.892Billable
Z62.898Billable
Z62.9Billable
Z63Z63.0Billable
Z63.1Billable
Z63.3Billable
Z63.31Billable
Z63.32Billable
Z63.4Billable
Z63.5Billable
Z63.6Billable
Z63.7Billable
Z63.71Billable
Z63.72Billable
Z63.79Billable
Z63.8Billable
Z63.9Billable
Z64Z64.0Billable
Z64.1Billable
Z64.4Billable
Z65Z65.0Billable
Z65.1Billable
Z65.2Billable
Z65.3Billable
Z65.4Billable
Z65.5Billable
Z65.8Billable
Z65.9Billable
Updates & Changes
FY 2026 Updates
Current Year
Deleted Codes
No codes deleted in this range for FY 2026
No significant changes for FY 2026
This range maintains stability with current coding practices
Historical Changes
- •FY 2025: Routine maintenance updates with minor terminology clarifications
- •FY 2024: Enhanced specificity requirements for certain code ranges
- •FY 2023: Updated documentation guidelines for improved clarity
Upcoming Changes
- •Proposed updates pending review by Coordination and Maintenance Committee
- •Under consideration: Enhanced digital health integration codes
Implementation Guidance
- •Review all FY 2026 updates for Z55-Z65 codes before implementation
- •Always verify the most current codes in the ICD-10-CM manual
- •Ensure clinical documentation supports the selected diagnosis codes
- +3 more guidance items...
Range Overview
high priority
The ICD-10 category Z55-Z65 is designed to capture potential health hazards related to socioeconomic and psychosocial circumstances. These codes are used to document a patient's social and economic circumstances that may affect their health status but are not in themselves a current illness or injury. They include issues like illiteracy, unemployment, poverty, and exposure to negative life events.
Key Usage Points:
- •These codes can be used in any healthcare setting, not just in social work or mental health.
- •They can be used as secondary codes to provide additional context for a patient's health.
- •They should not replace codes for current illnesses or injuries.
- •They can be used to justify referrals to social services or other resources.
- •They may be used in population health management to identify social determinants of health.
Coding Guidelines
When to Use:
- ✓When a patient's socioeconomic or psychosocial circumstances are affecting their health.
- ✓When a patient's circumstances may affect their ability to follow a treatment plan.
- ✓When a patient's circumstances may affect their prognosis.
- ✓When a patient's circumstances justify a referral to social services.
When NOT to Use:
- ✗When a patient's circumstances are not affecting their health.
- ✗When a patient's circumstances are not relevant to their current healthcare.
- ✗When a patient's circumstances are not documented in the medical record.
- ✗When a patient's circumstances are not a current issue.
Code Exclusions
Always verify that the patient's circumstances are documented in the medical record and are relevant to their current healthcare.
Documentation Requirements
Documentation for these codes should include a clear description of the patient's socioeconomic or psychosocial circumstances, and how they are affecting the patient's health. The documentation should also include any relevant history, and any actions taken or planned in response to these circumstances.
Clinical Information:
- •Description of the patient's circumstances
- •How the circumstances are affecting the patient's health
- •Relevant history
- •Actions taken or planned
Supporting Evidence:
- •Notes from social work or mental health consultations
- •Notes from discussions with the patient or their family
- •Referrals to social services or other resources
Good Documentation Example:
Patient is unemployed and struggling to afford medications. Referred to social worker for assistance with medication costs.
Poor Documentation Example:
Patient is unemployed.
Common Documentation Errors:
- âš Not documenting how the patient's circumstances are affecting their health
- âš Not documenting any actions taken or planned
- âš Using these codes to replace other codes
Range Statistics
10
Total Codes
127
Billable
Complexity:
Medium
Primary Use:Clinical Documentation
Chapter:21
Coding Complexity
Medium
Complexity Rating
These codes require a good understanding of the patient's circumstances and how they are affecting their health, as well as the appropriate actions to take in response. They also require a good understanding of the ICD-10 coding guidelines for these codes.
Key Factors:
- â–¸Understanding the patient's socioeconomic and psychosocial circumstances
- â–¸Understanding how these circumstances are affecting the patient's health
- â–¸Understanding the appropriate actions to take in response to these circumstances
- â–¸Understanding the ICD-10 coding guidelines for these codes
Specialty Focus
These codes are particularly relevant in specialties like social work, mental health, and primary care, but can be used in any healthcare setting.
Primary Specialties:
Social work
30%
Mental health
25%
Primary care
45%
Clinical Scenarios:
- • Patient with diabetes who is struggling to afford healthy food
- • Patient with depression who is unemployed and facing homelessness
- • Patient with hypertension who is illiterate and struggling to understand their treatment plan
- • Patient with cancer who is a single parent and struggling to manage their treatment and childcare
- • Patient with chronic pain who is a veteran and struggling with PTSD
Resources & References
The official ICD-10 coding guidelines are the primary resource for these codes. Other useful resources include clinical reference books and articles on social determinants of health.
Official Guidelines:
- ICD-10-CM Official Guidelines for Coding and Reporting
- ICD-10-CM Coding Handbook
- ICD-10-CM Coding Workbook
Clinical References:
- Articles on social determinants of health
- Books on social work in healthcare
Educational Materials:
- ICD-10 coding training courses
- Webinars on social determinants of health
Frequently Asked Questions
Can these codes be used as primary codes?
Yes, these codes can be used as primary codes if the patient's socioeconomic or psychosocial circumstances are the primary reason for the encounter.