2025 ICD-10-CM code Z55
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Social Determinants of Health - Problems related to education and literacy Factors influencing health status and contact with health services (Z00-Z99) Feed
Problems related to education and literacy, encompassing issues like illiteracy, lack of schooling, underachievement, and educational maladjustment.
Modifiers are not applicable to ICD-10 codes.
Medical necessity is established when the educational challenges demonstrably impact the patient's ability to access or benefit from healthcare services or when they directly affect the patient's overall health and well-being.Documentation of this impact is critical.
The clinical responsibility is to document and code the social determinant of health impacting the patient's overall health and well-being.This often involves a social worker or care coordinator.
- Factors influencing health status and contact with health services (Z00-Z99)
- Z55-Z65 (Persons with potential health hazards related to socioeconomic and psychosocial circumstances)
In simple words: This code describes problems related to a person's education or ability to read and write. This could include things like not having enough education, doing poorly in school, or having trouble getting along with teachers or classmates. These problems can affect a person's health.
ICD-10-CM code Z55, "Problems related to education and literacy," classifies issues impacting an individual's health due to educational factors.This includes illiteracy, lack of access to schooling, underachievement in school, possessing less than a high school diploma or GED, educational maladjustment, and discord with teachers or classmates.These factors can significantly influence health outcomes and are considered social determinants of health.
Example 1: A 30-year-old patient presents to the clinic for a routine check-up.During the visit, it is revealed that the patient is functionally illiterate and struggles to understand medical instructions or manage their medications effectively. Code Z55 is applied to reflect this barrier to healthcare., A 16-year-old patient is referred to a social worker due to consistent underachievement in school and significant conflict with teachers.The social worker assesses the patient and determines that these educational challenges negatively impact their mental and emotional well-being. Z55 is used to capture the impact of these factors., A 45-year-old patient, unemployed and struggling financially, has difficulty understanding and accessing community resources due to low literacy. This impacts their ability to access preventative care, leading to health deterioration. The patient is assigned Z55 to reflect this.
Thorough documentation is crucial and should include details of the educational challenges, their impact on the patient's health and well-being, and any interventions undertaken to address the situation.This may involve notes from teachers, school records, or social worker assessments.
** While Z55 is used to capture the impact of educational challenges, it's crucial to code any underlying mental health conditions separately, as these often coexist.
- Revenue Code: Revenue codes will vary depending on the specific services provided and the payer.Consult your payer's guidelines.
- RVU: RVUs are not applicable to ICD-10 codes.RVUs are associated with CPT codes which represent procedures or services.
- Global Days: Not applicable to ICD-10 codes.
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD-10 codes.
- Fee Schedule: Not applicable to ICD-10 codes.
- Specialties:Social work, primary care, pediatrics, psychiatry
- Place of Service:Office, Hospital, Outpatient clinic, School, Community health center