Trends in the use of SDOH ICD10 across time, geography, market and service type

Background

Robust capture of social determinants of health in administrative claims data would enable health systems and payers to identify and address SDOH at scale, but adoption of these codes has been slow. Studies that describe the prevalence of SDOH related ICD10 codes (“z-codes”) have focused on specific sites of care or subpopulations, and to date, no analysis has measured use rates across all major payer types and geographies. 

Objective

To describe how the documentation of SDOH through z-codes has varied over time, geography, payer type, place of service and provider specialty. 

Methods

We leveraged multiple large administrative claims databases to ensure robust, national coverage including: 

• CMS Medicare 100% Research Identifiable Files and T-MSIS data, including claims, encounters, and enrollment records for nearly all Medicare, Medicaid, and CHIP beneficiaries.
• Proprietary commercial market datasets containing claims and enrollment records for over 100 million insured lives.

We summarized the percent of claims, members, and providers with at least one Z-code on a claim by state, payer type, and year from 2016 – 2022. We also described use rates of the three digit- and full ICD10 z-codes by state, payer type, place of service and provider specialty for 2022.

Results

Preliminary results show that the rate of z-code documentation varies widely across all dimensions studied. Nationally, rates of documentation have increased over time for all payer types when measured by number of members with a claim, as well as number of providers documenting at least one z-code. Generally, z-codes related to upbringing and primary support are used most frequently, and prevalence of these codes is highest among behavioral health care providers. 

Conclusion
Understanding patterns of SDOH ICD10 coding can inform data collection strategies, analytical activities, and intervention planning. Current trends indicate that substantial opportunities to improve collection and reporting of SDOH information through ICD10 codes still exist.

Presentation slides