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Analyzing pediatric department documentation of patient social needs with ICD-10 Z-codes
Oluwatofunmi Jummie Akinwunmi1, Deron Galusha2, Baylah Hooper2
1Yale School of Public Health, New Haven, Connecticut, USA. jummie.akinwunmi@aya.yale.edu.
Insights
Social needs documentation using ICD-10 Z-codes is low in pediatric care, indicating potential underestimation of patient needs. Further research is needed to improve identification and documentation processes.
Area of Science:
- Public Health
- Health Informatics
- Pediatrics
Background:
- The International Classification of Diseases, 10th Revision (ICD-10) enables social needs documentation via Z-codes.
- Z-code data can identify at-risk pediatric populations for interventions.
- Underutilization of Z-codes in pediatrics is a concern.
Purpose of the Study:
- To examine ICD-10 Z-code documentation rates in a pediatric outpatient setting.
- To analyze documentation by specialty type and age group within a large health system.
Main Methods:
- Cross-sectional study of electronic health records (2019-2020).
- Descriptive statistics to calculate Z-code documentation proportion.
- Comparison of documentation rates across specialties and age groups.
Main Results:
- 1.9% of pediatric patients had documented ICD-10 Z-codes.
- School-based health centers (10.6%) and pediatric primary care (5.3%) had highest documentation rates.
- Patients aged 22-30 in primary care were more likely to have Z-codes documented.
Conclusions:
- Overall ICD-10 Z-code documentation for pediatric social needs is low.
- Current documentation may not reflect true social needs.
- Further study is required to optimize pediatric social needs identification and documentation.
Background:
The 10th revision of the International Classification of Diseases (ICD-10) allows healthcare professionals to document social needs with ICD-10 Z-codes. Data derived from the documentation of ICD-10 Z-codes can be leveraged to identify at-risk populations for targeted intervention. However, there remains concern for underutilization of these codes, particularly in the pediatric population. We sought to examine the documentation of ICD-10 Z-codes in the pediatric outpatient setting of the largest Connecticut health system by specialty type and age group.
Methods:
In this cross-sectional study, we examined deidentified electronic health records of pediatric outpatient patients seen within the Yale New Haven Health System in Connecticut from 2019 to 2020. We used descriptive statistics to measure the proportion of patients with at least one social needs-related ICD-10 Z-code. We compared the rates of documentation across different specialty types and age groups. We also identified nine categories of ICD-10 Z-codes and compared differences in the distribution of Z-code categories across age groups.
Results:
A total of 1,164 out of 59,867 pediatric outpatient patients (1.9%) from 2019 to 2020 had at least one documented ICD-10 Z-code. Across all ages, the specialty type with the highest rate of documentation was school-based health centers (10.6%), followed by pediatric primary care (5.3%). Within the pediatric primary care group, we found that patients aged 22 to 30 were significantly more likely than all other age groups to have an ICD-10 Z-code documented.
Conclusions:
We demonstrate that social needs documentation with ICD-10 Z-codes in the pediatric department of this health system is low overall and likely unreflective of the true social needs of the population. These findings suggest the need for further study of how pediatric social needs are identified, documented, and operationalized within clinical workflows.
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