CMS MACBIS T-MSIS Reporting Reminder: Reporting ICD-10-CM Diagnosis Codes with clarification on “Z Codes” for Social Determinants of Health (SDOH)

ICD-10-CM diagnosis codes related to social determinants of health (SDOH), such as housing, employment, and food insecurity, range from Z55-Z65. These codes are a subset of “Z Codes” Z00-Z99 that are used to identify “factors influencing health status and contact with health services”. Use of SDOH “Z Code” data can help improve care coordination, patient experience, and health outcomes. Like all other ICD-10-CM codes, “Z Codes”, including those related to SDOH, are reported using the various DIAGNOSIS-CODE data elements in the T-MSIS Claims files (Claim IP, Claim LT, and Claim OT).

As of the V4.0.0 T-MSIS Data Dictionary, each of the claim IP, LT, OT and RX files have a separate CLAIM-DX segment type (CIP00004, CLT00004, COT00004, and CRX00004) for reporting Diagnosis Codes. Multiple CLAIM-DX segment types can be reported per claim, which enables states to submit the number of CLAIM-DX segments needed to report all diagnosis related information. Additionally, the diagnosis code data elements were removed from the CLAIM-HEADER segment type (CIP00002, CLT00002, CLT00002, CRX00002).

Tables 1 and 2 provide more information on the deprecated and added data elements for reporting diagnosis code as of the V4.0.0. Data Dictionary.

Table 1. Deprecated Data Elements as of T-MSIS V4.0.0 Data Dictionary

Table 2. Newly ADDED Data Elements as of T-MSIS V4.0.0 Data Dictionary

The following information applies to all ICD-10-CM diagnosis codes, including “Z codes” described above.

• States should report diagnosis codes in T-MSIS in the order that they come in on the claim.
• States should report as many diagnosis codes as the T-MSIS architecture allows.
• For assistance, please refer to the ICD-10-CM Official Guidelines for Coding and Reporting.