Z-codes: The first step in overcoming barriers to social determinants of health documentation

From “walked into lamppost” to “struck by duck,” the 2015 revision of the International Classification of Disease (ICD-10) offered new codes to describe some of the obscurest circumstances for medical documentation. Perhaps less widely recognized, this edition also gave birth to a subset of codes to document problems of undoubtedly higher prevalence: health-related social needs (HRSN). Despite the well-known clinical significance of social determinants of health (SDOH), several studies in adult inpatient literature show that these “Z-codes” are vastly underutilized.1–5In this issue of Pediatrics, McQuistion et al6 compared 2016 and 2019 data from the Kids Inpatient Database to identify differences in use of SDOH Z-codes or related ICD-10 codes recommended by the American Academy of Pediatrics, stratified by patient and hospital characteristics. Similar to adult literature, they found that SDOH code use increased with time but remained underutilized, with the most documentation seen for adolescents, Native Americans, and those with mental health diagnoses and in freestanding children’s hospitals (likely given proximity to urban environments).1