Behind the code: Homelessness Z59.0

I was on an internal 3M call recently, listening to the engineers as they were developing ICD-10 codes for the Z59 series---problems related to housing and economic circumstances.  Coincidentally, my family and I had volunteered that week at a soup kitchen in one of the largest towns in Massachusetts. Having just had the experience of working with the homeless population coupled with a meeting specifically about Z59.0, and I started to think more about ICD-10 Z59.0. As coders, we are telling a story: What does the story look like for a homeless person? How does it affect their health? Can I as a coder help? 

According to National Alliance to End Homelessness, 17 out of 10,000 people are homeless, with approximately 67 percent homeless individuals and 33 percent homeless families with children. The data on the website reflect a steady increase in the rate of homelessness. Homelessness directly affects health and exposure to the elements in regions with harsher weather puts individuals at higher risk for hypothermia and frostbite. Diseases that are common among the homeless population include heart disease, cancer, liver disease, kidney disease, skin infections, HIV/AIDS, pneumonia, and tuberculosis (O’Connell, 2005).  Community health centers are reporting that they are serving patients with complex needs. The national association of community health centers mission is to provide health care to those that are underserved. 

As coders, we can help by reflecting the patient’s story with the use of ICD-10 codes. Reporting Z59.0 identifies a patient population as well as their complex needs. In turn, this informs policy as well as payment methodologies. “This is one way of demonstrating through the data that you have a more medically complex person,” says Barbara DiPietro of the National Health Care for the Homeless Council. The NHCHC cites several reasons for using Z59.0 to document homeless patients:

• The ability to compare data across provider organizations
• The opportunity to signal patient’s high-risk acuity to various providers when patients and their medical records move within and across systems
• The ability to document the medical complexity of a system’s patient population compared with that of other providers
• A way to track medical outcomes of a system’s homeless patients
• A reduced chance that providers will be financially penalized under value-based payment methods for serving high-needs populations

As a coder, it is imperative to code in a way that accurately reflects the patient story. Our codes inform clinicians and alert them to patient needs. Correct coding also provides accurate information so resources can be allocated to this complex group of patients who often have chronic conditions. Our daily tasks can have an indirect link to helping this vulnerable population.

Jean Jones is a coding analyst at 3M Health Information Systems.