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v1.0.0
ICD-10 Guide
ICD-10 CodesZ59.6

Z59.6

Low income

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

Code Description

ICD-10 Z59.6 is a billable code used to indicate a diagnosis of low income.

Key Diagnostic Point:

Z59.6 represents low income as a social determinant of health, which can significantly influence an individual's health status and access to healthcare services. Individuals classified under this code often face barriers to obtaining necessary preventive care, screenings, and aftercare due to financial constraints. Low income can lead to increased stress, poor nutrition, and limited access to health resources, which can exacerbate existing health conditions or lead to new health issues. Preventive care is crucial for this population, as it can help mitigate the long-term effects of chronic diseases that are often more prevalent in low-income groups. Screening for conditions such as hypertension, diabetes, and mental health disorders is essential to identify and address health issues early. Aftercare services, including follow-up appointments and management of chronic conditions, are also vital to ensure continuity of care and improve health outcomes. Proper documentation of low income as a social determinant is essential for understanding the broader context of a patient's health and for tailoring interventions that address these social factors.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for comprehensive documentation of social determinants of health.
  • Variability in patient income levels and associated health impacts.
  • Potential overlap with other Z codes related to social determinants.
  • Requirement for accurate coding to reflect the primary reason for healthcare encounters.

Audit Risk Factors

  • Inadequate documentation of income status and its impact on health.
  • Failure to link low income to specific health outcomes or interventions.
  • Misuse of Z59.6 when a more specific diagnosis is applicable.
  • Inconsistent coding practices across different healthcare providers.

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation should include patient income level, barriers to care, and any related health issues.

Common Clinical Scenarios

Routine checkups where income-related barriers affect access to preventive services.

Billing Considerations

Consideration of how low income affects adherence to treatment plans and follow-up care.

Public Health

Documentation Requirements

Population-level data on income and health outcomes, including surveillance of health disparities.

Common Clinical Scenarios

Community health assessments and epidemiological studies focusing on low-income populations.

Billing Considerations

Tracking health status and outcomes in relation to socioeconomic factors.

Coding Guidelines

Inclusion Criteria

Use Z59.6 When
  • Z codes should be used when the reason for the encounter is not a current illness or injury but relates to social determinants affecting health
  • 6 can be sequenced as a secondary diagnosis to provide context for the primary diagnosis
  • Payer requirements may vary, so it is essential to verify coverage for services related to social determinants

Exclusion Criteria

Do NOT use Z59.6 When
No specific exclusions found.

Related CPT Codes

99381CPT Code

Preventive medicine, new patient, under 1 year

Clinical Scenario

Used for preventive visits in low-income children to assess growth and development.

Documentation Requirements

Document income status and barriers to care.

Specialty Considerations

Primary care providers should assess social determinants during well-child visits.

99406CPT Code

Smoking cessation counseling visit

Clinical Scenario

Counseling for low-income patients struggling with smoking addiction.

Documentation Requirements

Document income-related barriers to cessation resources.

Specialty Considerations

Public health initiatives may focus on smoking cessation in low-income communities.

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 low income. This specificity helps healthcare providers and payers better understand the impact of socioeconomic factors on health outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding social determinants of health, including low income. This specificity helps healthcare providers and payers better understand the impact of socioeconomic factors on health outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding social determinants of health, including low income. This specificity helps healthcare providers and payers better understand the impact of socioeconomic factors on health outcomes.

Resources

Clinical References

  • •
    CDC Social Determinants of Health
  • •
    Healthy People 2030

Coding & Billing References

  • •
    CDC Social Determinants of Health
  • •
    Healthy People 2030

Frequently Asked Questions

How should I document low income in patient records?

Document the patient's income level, any financial barriers to accessing care, and how these factors may impact their health. This information is crucial for coding Z59.6 accurately and for tailoring care to meet the patient's needs.