Cracking the Code: Enhancing SDOH Documentation with ICD-10-CM Z codes

Introduction: Social determinants of health (SDOH) have a large impact on health outcomes with the World Health Organization (WHO) estimating that SDOH accounts for nearly 30-55% of patient health outcomes. Addressing SDOH especially in primary care clinics can lead to reduced barriers to care and improvement in health outcomes. At WSUSOM, there is curricular emphasis on gaining knowledge of SDOH, but this does not always translate to clinical practice. Currently, ICD-10-CM Z Codes are being used to report SDOH and other factors influencing patients’ health status. We would like to investigate how SDOH is currently being documented and create an intervention to improve documentation practices and the usage of ICD-10-CM Z codes. Methods: A retrospective chart review will be conducted at the GMAP clinic at University Health Center to establish baseline frequency of SDOH documentation and Z Code usage. The review will analyze components of social history, resources provided, common diagnoses associated with Z codes, relevant demographics, etc. An intervention will be created for resident physicians, including a training session and educational material to improve understanding and utilization of Z codes. Patient charts will be reviewed from clinic appointments after the intervention to assess changes in documentation practices. Results: Researchers hypothesize that the intervention will improve SDOH documentation practices and increase the use of ICD-10 CM Z codes at the GMAP clinic. Conclusion: This study will ultimately address how to better mitigate barriers to care due to effects of SDOH by improving documentation practices in the primary care setting.