Low Rate of Social Determinants of Health Z Codes in Adults With Hypertension

The proportion of patients with documented ICD-10-CM social determinants of health (SDOH)–related Z codes was below 4% for commercial, Medicare Supplement, and Medicaid beneficiaries with hypertension, according to a study published online in AJPM Focus.

“This seems to be contrary to the findings of national research that suggests that more than half (54%) of US adults with low income had unmet social needs…” wrote researchers from the Centers for Disease Control and Prevention Division for Heart Disease and Stroke Prevention in Atlanta, Georgia. “Adoption of SDOH-related Z codes has been slow because of a misunderstanding that only physicians can document a patient’s social needs, the absence of standard operating procedures for documenting and coding, and unfamiliarity with SDOH-related Z codes among health care administrators, providers, and coders.”

The study looked at SDOH-related Z codes (Z55–Z65) for more than 1 million patients with commercial insurance, 296,340 patients with private insurance to supplement Medicare, and 146,484 patients with Medicaid. All patients in the study had a diagnosis of hypertension.

In 2020, the proportion of SDOH-related Z codes was 3.02% in the Medicaid group, 0.46% in the commercial group, and 0.42% in the Medicare Supplement group. 

“In our study, SDOH-related Z codes were approximately 7 times higher among Medicaid beneficiaries than among commercial and Medicare beneficiaries,” researchers pointed out. “This may reflect screening and documenting practices and patient needs.”

For every group, documentation of SDOH-related Z codes was higher for inpatient claims than outpatient claims, according to the study. Patients with SDOH-related Z codes had more chronic conditions than other patients, and their 2019 medical costs were more than 1.5 times higher.

“Documentation of social needs through SDOH-related Z codes provides an actionable opportunity to integrate social and medical data,” researchers wrote. “Our study of adults suggests that this may be a missed opportunity to addressing nonclinical needs that affect hypertension and other health outcomes and health care costs.”

Reference: 
Lee JS, MacLeod KE, Kuklina EV, Tong X, Jackson SL. Social determinants of health–related Z codes and health care among patients with hypertension. AJPM Focus. 2023:2(2):100089. doi.org/10.1016/j.focus.2023.100089