Analyzing pediatric department documentation of patient social needs with ICD-10 Z-codes

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.