Z-Codes, integrated into healthcare coding to capture Social Determinants of Health (SDOH), face troubling underutilization. Two studies conducted by distinct institutions showcased limited Z-Code applications, primarily focusing on housing insecurity. Despite potential benefits, Z-Codes are sparingly employed across various SDOH domains. Differences arise between Medicaid and commercially insured patients, impacting Z-Code usage related to economic hardships versus social relationships. The findings underscore inadequate documentation of non-medical patient needs. This highlights the urgent necessity for comprehensive training programs and robust systems to bridge the gap in understanding and addressing SDOH across healthcare settings.
The inclusion of Z-Codes in the ICD-10 coding system was aimed at comprehensively cataloging Social Determinants of Health (SDOH). However, recent research elucidates a troubling trend of these codes being infrequently used. Despite their potential in identifying SDOH, Z-Codes are notably absent in healthcare documentation, aside from instances of housing insecurity. Differences in application among Medicaid and commercially insured patients signify a crucial disparity in acknowledging economic adversities versus social relationships. These gaps highlight the pressing need for enhanced strategies to document and address the multifaceted non-medical needs of patients within healthcare systems.
Researchers from the NYU School of Global Public Health conducted the initial study, shedding light on the inadequate usage of Z-codes across diverse SDOH domains. While over half of the hospitals examined applied Z-codes to denote housing insecurity, the overall adoption of Z-codes for other SDOH elements remained significantly low.
In a separate study led by experts from the Colorado School of Public Health and Johns Hopkins, findings indicated a 50% higher frequency of Z-code utilization among Medicaid beneficiaries compared to those commercially insured. Notably, these codes were predominantly used within mental health or psychiatric care settings.
Despite their potential significance in healthcare coding for SDOH, the data starkly displays their underwhelming implementation. Throughout the assessment period of 2017-2021, approximately 56% of nearly 6,000 US hospitals integrated at least one Z-code annually, yet the diversity in Z-code application remained limited.
Z59, about housing and economic circumstances, emerged as the most commonly employed Z-code, used by 56% of the observed hospitals. The usage of other types of Z-codes was notably sparse, with fewer than 10% of hospitals employing them.
The research also identified certain hospital demographics—such as general medicine facilities, teaching hospitals, larger health system affiliates, and medium to large-sized hospitals—as more inclined toward Z-code usage. However, this prevalence raised concerns about healthcare settings’ readiness to comprehend the holistic spectrum of SDOH.
The researchers highlighted the necessity for comprehensive training programs emphasizing all SDOH domains. They suggested establishing robust systems and partnerships to address the multitude of non-medical needs patients might present, extending beyond housing.
Similarly, the second study highlighted the dismal utilization of Z-codes, emphasizing disparities in their application among different patient demographics and care settings. Medicaid patients were more likely to receive Z-codes relating to economic adversities, while commercially insured patients tended to receive codes linked to social relationships.
The divergence in Z-code documentation locations was also notable, with mental health and psychiatric settings being the most common. However, Medicaid patients primarily received Z-codes in inpatient settings, while commercially insured patients tended to receive them in outpatient settings.
Dr. Jason Gibbons, the lead author of the second study and an assistant professor and health economist at the Colorado School of Public Health, emphasized the urgent need for healthcare facilities to identify and document social factors affecting patient health more comprehensively. He suggested that integrating Z-codes into certain quality payment models and 1115 waiver programs could potentially stimulate wider utilization. Moreover, Gibbons stressed the importance of enhanced provider education to address this critical issue effectively.
The stark underutilization of Z-Codes across Social Determinants of Health (SDOH) realms unveils a significant gap in healthcare documentation. Disparities between Medicaid and commercially insured patients further exacerbate the issue, emphasizing distinct needs related to economic adversities and social relationships. Bridging this gap demands comprehensive training programs and robust partnerships within healthcare settings to accurately capture and address patients’ diverse non-medical needs. Integrating Z-Codes into quality payment models and enhancing provider education are crucial steps in addressing this critical issue, fostering a more comprehensive understanding and approach towards SDOH within healthcare systems.
