What Does Medical Coding Have to Do with Health Equity?

In Socially Determined: The Healthcare Executive's Role in Health Equity, we structured every chapter title as a question—questions we frequently encountered while researching the book. While the question in this article’s title is not a chapter heading, the role of Z codes in measuring social determinants of health (SDOH) is explored in Chapter 11, Can We Measure What Matters?

SDOH and health-related social needs (HRSNs) influence up to 80% of quality outcomes and healthcare spending. Yet, if clinicians only see a patient’s medical diagnoses, they miss a significant part of the picture. That’s why CMS has embedded equity-focused quality measures into its regulations, including the latest Inpatient Prospective Payment System (IPPS) final rule.

While these measures remain in effect today, future policy changes could shift the landscape. Regardless of regulatory updates, healthcare organizations must prepare for increasing numbers of patients with unmet HRSNs—especially if funding cuts exacerbate existing disparities. This makes screening for HRSNs and connecting patients to community resources more essential than ever.

Starting next year, the new Patient Safety Structural Measure (PSSM) will require healthcare boards to review and discuss quality topics at every meeting. Health equity is inseparable from quality—ensuring that care does not vary based on personal characteristics is the foundation of patient safety. To achieve this, organizations must first document these characteristics in a structured, standardized way. That’s where Z codes come in.

Z codes provide a structured way to capture key social factors affecting patient health:

• Z55.6 – Identifies patients with difficulty understanding medication instructions, highlighting a need for additional education or support.
• Z59.11 – Explains why a patient repeatedly visits the ER for heat-related issues in the middle of a hot, humid summer—they lack air conditioning.
• Z59.61 – Indicates that a patient does not have health insurance, which can impact treatment decisions.
• Z60.2 – Identifies individuals living alone, a crucial factor as aging populations may lack nearby caregivers.

By documenting these social determinants, clinicians can better assess risk, justify medical necessity, support value-based care arrangements, and measure quality improvement efforts.

To explore how Z codes can enhance health equity efforts, join me on May 14 at the Illinois Health and Hospital Association for a webinar, Socially Determined: Enhancing Health Equity through Z Codes and SDOH Data. By May, we should have greater clarity on evolving regulations and requirements—making this an essential update for healthcare leaders committed to advancing health equity.