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v1.0.0
ICD-10 Guide
ICD-10 CodesZ59.87

Z59.87

Material hardship due to limited financial resources, not elsewhere classified

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

Code Description

ICD-10 Z59.87 is a billable code used to indicate a diagnosis of material hardship due to limited financial resources, not elsewhere classified.

Key Diagnostic Point:

Z59.87 captures the impact of material hardship stemming from limited financial resources on an individual's health status and access to healthcare services. This code is essential for recognizing how financial constraints can lead to barriers in obtaining preventive care, screenings, and necessary aftercare. Patients facing material hardship may experience increased stress, poor nutrition, and inadequate housing, which can exacerbate existing health conditions and hinder recovery. By documenting this Z code, healthcare providers can better address the social determinants of health that influence patient outcomes, ensuring that care plans are comprehensive and tailored to the needs of vulnerable populations. This code is particularly relevant in preventive care settings where addressing social factors can lead to improved health outcomes and reduced healthcare costs.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires thorough documentation of financial hardship and its impact on health.
  • May involve multiple social determinants that need to be assessed.
  • Potential for misinterpretation of the patient's financial situation.
  • Need for integration with other Z codes for comprehensive coding.

Audit Risk Factors

  • Inadequate documentation supporting the financial hardship claim.
  • Failure to link the Z code to relevant clinical conditions.
  • Misuse of the code in non-applicable scenarios.
  • Inconsistent coding practices across different providers.

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Document financial assessments, social history, and any barriers to care.

Common Clinical Scenarios

Routine checkups where financial hardship affects access to medications or follow-up care.

Billing Considerations

Consideration of how financial stress impacts mental health and adherence to treatment plans.

Public Health

Documentation Requirements

Population-level data on financial hardship and its health impacts.

Common Clinical Scenarios

Community health assessments and epidemiological studies focusing on socioeconomic factors.

Billing Considerations

Tracking health disparities and developing targeted interventions.

Coding Guidelines

Inclusion Criteria

Use Z59.87 When
  • Z codes should be used when they provide additional information about the patient's health status or social circumstances
  • 87 should be sequenced appropriately, often as a secondary diagnosis, to highlight the impact of financial hardship on health outcomes
  • Payer requirements may vary, so coders should verify specific documentation needs

Exclusion Criteria

Do NOT use Z59.87 When
No specific exclusions found.

Related CPT Codes

99381CPT Code

Preventive medicine, new patient, established patient

Clinical Scenario

Used during routine checkups where financial hardship is documented.

Documentation Requirements

Document financial barriers impacting care.

Specialty Considerations

Primary care providers should assess social determinants during 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 financial hardship. Z59.87 provides a clear mechanism for capturing the impact of socioeconomic factors on health outcomes, which was less defined in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding social determinants of health, including financial hardship. Z59.87 provides a clear mechanism for capturing the impact of socioeconomic factors on health outcomes, which was less defined in ICD-9.

Reimbursement & Billing Impact

financial hardship. Z59.87 provides a clear mechanism for capturing the impact of socioeconomic factors on health outcomes, which was less defined in ICD-9.

Resources

Clinical References

  • •
    CDC Social Determinants of Health

Coding & Billing References

  • •
    CDC Social Determinants of Health

Frequently Asked Questions

When should Z59.87 be used?

Z59.87 should be used when a patient's financial hardship is impacting their health status or access to care. It is important to document specific instances of how financial constraints affect the patient's ability to receive preventive services or adhere to treatment plans.