Z code use inches up as Medicare providers document SDOH data

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Progress is being made in the Medicare program to document a subset of ICD-10-CM codes used to capture social determinants of health data.

While Z codes did not exist prior to implementation of the ICD-10-CM codes in 2015, a new report from the Centers for Medicare and Medicaid Services finds that providers used the SDOH-associated coding for 467,136 Medicare fee-for-service beneficiaries in 2017—nearly 5 percent more beneficiaries than in 2016.

At the same time, CMS notes that this represents just 1.4 percent of the 33.7 million total Medicare FFS beneficiaries in 2017.

“This data highlight provides insight into the limited documentation of social determinants of health for Medicare FFS beneficiaries,” states the report, which is the first analysis of claims data to determine the extent to which Z codes are being used.

Nonetheless, according to CMS, the top five most utilized Z codes in 2017 were those for homelessness; problems related to living alone; disappearance and death of family members; other specified problems related to psychosocial circumstances; and problems in relationship with a spouse or partner.

“SDOH data collection can lead to an increase in patient referrals to supportive services and help identify population-level trends that have both health and cost implications,” states the report. “However, more widely adopted and consistent documentation is needed to more comprehensively identify social needs, and monitor progress in addressing them.”

CMS also points out that “data collection using SDOH screening tools is quite common across settings, but this captured information is not consistently translated to standardized data due to lack of technical specifications based on industry consensus.”

To address the problem, a multi-stakeholder initiative—called the Gravity Project—is working on standardizing key data elements necessary for documenting and sharing SDOH-related screening, diagnosis and treatment information using modern coding and exchange standards.

Also See: Project makes early progress in trying to standardize SDOH data

The Gravity Project is initially focused on consensus-driven standards for three SDOH domains—food security, housing stability and quality, and transportation access. According to the Gravity Project website, so far the food insecurity dataset has been “consensus approved” by the community.

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