Hospital Use of Common Z-Codes for Medicare Fee-for-Service Beneficiaries 2017-2021

Recognizing the impact of the social determinants of health (SDOH) on health outcomes, in 2016, the Centers for Medicare and Medicaid Services recommended use of ICD-10 Z-Codes to capture patients’ health related social needs. We examined changes in Z-Code utilization to document health related social needs for Medicare Fee for Service recipients among U.S. hospitals between 2017 to 2021 across five common SDOH domains. We found that while 56.9 percent of hospitals had at least one Z-Code recorded in at least one patient per year, apart from those referring to housing needs, rates of Z-Code adoption were low. Additionally, hospitals that were general medical, part of a teaching institution, affiliated with larger health systems, and of medium to large size had greater odds of utilizing Z-Codes. Findings from this study highlight the need for continued efforts in promoting the consistent use of standardized SDOH capturing methods like Z-Code documentation, such as provider training.