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v1.0.0
ICD-10 Guide
ICD-10 CodesZ59.11

Z59.11

Inadequate housing environmental temperature

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/12/2025

Code Description

ICD-10 Z59.11 is a billable code used to indicate a diagnosis of inadequate housing environmental temperature.

Key Diagnostic Point:

Z59.11 refers to situations where individuals live in environments that do not maintain adequate temperatures, which can significantly impact health outcomes. This code is particularly relevant in the context of social determinants of health, as inadequate housing can lead to increased risks of respiratory illnesses, cardiovascular problems, and mental health issues. Preventive care strategies may include home assessments for temperature regulation, education on heating options, and referrals to social services for housing assistance. Screening for health issues related to inadequate housing is essential, especially in vulnerable populations such as the elderly, children, and those with chronic conditions. Aftercare may involve follow-up visits to assess the impact of housing conditions on health and to ensure that patients have access to necessary resources. Proper documentation is crucial to capture the social context influencing health status and to facilitate appropriate interventions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for comprehensive documentation of housing conditions
  • Variability in patient experiences and health outcomes
  • Potential overlap with other Z codes related to housing
  • Requirement for interdisciplinary collaboration for effective interventions

Audit Risk Factors

  • Insufficient documentation of housing conditions
  • Failure to link health issues directly to inadequate housing
  • Inconsistent coding practices among providers
  • Lack of follow-up documentation to support ongoing care

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Document patient housing conditions, health impacts, and any referrals made.

Common Clinical Scenarios

Routine checkups where housing conditions are discussed, screenings for respiratory issues in patients living in cold environments.

Billing Considerations

Consider social determinants and how they affect patient health and access to care.

Public Health

Documentation Requirements

Collect data on housing conditions for epidemiological studies and community health assessments.

Common Clinical Scenarios

Public health initiatives aimed at improving housing conditions and reducing health disparities.

Billing Considerations

Focus on population-level health impacts and tracking of housing-related health issues.

Coding Guidelines

Inclusion Criteria

Use Z59.11 When
  • Z codes should be used when the reason for the encounter is not a disease or injury but relates to social determinants of health
  • 11 should be sequenced appropriately, often as a secondary diagnosis to capture the impact on health
  • Payer requirements may vary, so it's essential to verify coverage for social determinants
  • related services

Exclusion Criteria

Do NOT use Z59.11 When
No specific exclusions found.

Related CPT Codes

99381CPT Code

Preventive medicine visit, new patient

Clinical Scenario

Used during routine checkups where housing conditions are assessed.

Documentation Requirements

Document housing conditions and any referrals made.

Specialty Considerations

Primary care providers should address social determinants during preventive visits.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding social determinants of health, including housing-related issues, which can lead to improved understanding and interventions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding social determinants of health, including housing-related issues, which can lead to improved understanding and interventions.

Reimbursement & Billing Impact

impact on health, including any preventive or screening services provided.

Resources

Clinical References

  • •
    CDC Social Determinants of Health

Coding & Billing References

  • •
    CDC Social Determinants of Health

Frequently Asked Questions

When should Z59.11 be used?

Z59.11 should be used when inadequate housing environmental temperature is impacting a patient's health, particularly in the context of preventive care and screenings.