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v1.0.0
ICD-10 Guide
ICD-10 CodesZ59.5

Z59.5

Extreme poverty

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

Code Description

ICD-10 Z59.5 is a billable code used to indicate a diagnosis of extreme poverty.

Key Diagnostic Point:

Extreme poverty is defined as living on less than $1.90 a day, which significantly impacts an individual's health status and access to healthcare services. Individuals in extreme poverty often face barriers such as inadequate nutrition, lack of stable housing, limited access to education, and insufficient healthcare resources. These factors contribute to a higher prevalence of chronic diseases, mental health issues, and increased mortality rates. Preventive care and screening are crucial for this population, as they often delay seeking medical attention due to financial constraints. Health services must be tailored to address the unique challenges faced by individuals in extreme poverty, including providing affordable care options and community resources. Effective documentation of Z59.5 is essential for understanding the social determinants of health and ensuring that appropriate preventive measures and aftercare are implemented.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for comprehensive documentation of social determinants of health.
  • Variability in patient presentation and associated health conditions.
  • Potential for co-morbidities that complicate coding.
  • Challenges in capturing the full impact of poverty on health outcomes.

Audit Risk Factors

  • Inadequate documentation linking poverty to health outcomes.
  • Failure to capture co-morbid conditions that may be influenced by poverty.
  • Improper sequencing of Z codes with primary diagnoses.
  • Lack of evidence for preventive services provided.

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Document social determinants impacting health, preventive care received, and follow-up plans.

Common Clinical Scenarios

Routine checkups for patients in poverty, screenings for chronic diseases, and aftercare for acute conditions.

Billing Considerations

Consideration of non-disease factors affecting health, such as housing instability and food insecurity.

Public Health

Documentation Requirements

Population-level data on health disparities, surveillance of health outcomes related to poverty.

Common Clinical Scenarios

Epidemiological studies assessing health impacts of poverty, community health initiatives targeting low-income populations.

Billing Considerations

Focus on health equity and access to care for marginalized communities.

Coding Guidelines

Inclusion Criteria

Use Z59.5 When
  • Z codes should be used when social determinants impact health status or healthcare utilization
  • They can be sequenced as secondary diagnoses when they influence the primary condition
  • Payer requirements may vary, so it's essential to check specific guidelines

Exclusion Criteria

Do NOT use Z59.5 When
No specific exclusions found.

Related CPT Codes

99381CPT Code

Preventive medicine visit, new patient

Clinical Scenario

Used for routine checkups in patients identified as living in extreme poverty.

Documentation Requirements

Document social determinants impacting health and preventive services provided.

Specialty Considerations

Primary care providers should assess barriers to care.

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 extreme poverty, which can help in understanding health disparities and improving care delivery.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding social determinants of health, including extreme poverty, which can help in understanding health disparities and improving care delivery.

Reimbursement & Billing Impact

impact on health, and any preventive or aftercare services provided.

Resources

Clinical References

  • •
    CDC Social Determinants of Health

Coding & Billing References

  • •
    CDC Social Determinants of Health

Frequently Asked Questions

When should Z59.5 be used in coding?

Z59.5 should be used when a patient's extreme poverty significantly impacts their health status or access to healthcare services, particularly in preventive and aftercare contexts.