Using Z Codes to Document Social Risk Factors in the Electronic Health Record: A Scoping Review

Area of Science:

• Health Informatics
• Social Determinants of Health
• Medical Coding

Background:

• Individual social risk factors significantly impact health outcomes.
• Electronic health records can document social risks using ICD-10 diagnosis codes (Z codes).
• This study synthesizes existing literature on Z code utilization for social risk documentation.

Purpose of the Study:

• To conduct a scoping review of literature on the use of Z codes for documenting social risks.
• To identify trends and patterns in Z code utilization rates.
• To inform strategies for increasing social risk documentation to improve patient health.

Main Methods:

• A comprehensive scoping review was performed using major databases (PubMed, Medline, CINAHL, Web of Science).
• Included studies were published in English in peer-reviewed journals before June 2024 and reported Z code utilization rates in the United States.
• Data extraction focused on Z code utilization rates, patient/encounter demographics, and associated healthcare utilization.

Main Results:

• Thirty-two articles met the inclusion criteria.
• Z code utilization rates varied widely: 0.4%-17.6% (patient-level) and 0.1%-3.7% (encounter-level), with medians of 1.2% and 1.4%, respectively.
• Most frequently reported codes were Z59 (housing/economic), Z63 (support group), and Z62 (upbringing). Patients with Z codes were often younger, male, non-White, and had higher healthcare costs.

Conclusions:

• Current Z code utilization for social risk documentation in healthcare settings is low.
• Growing research interest suggests potential for increased adoption.
• Enhanced Z code documentation is crucial for addressing social determinants of health and improving overall health outcomes.