Z-code documentation to identify social determinants of health among Medicaid beneficiaries

Abstract

Introduction: Social determinants of health (SDoH) are non-medical factors that impact individuals' health. SDoH can be documented in claims data using International Classification of Disease (ICD) 10th revision codes Z55 - Z65. The study objective was to describe the documentation of SDoH Z-codes among Medicaid beneficiaries in Texas.

Methods: Texas Medicaid medical and enrollment claims data were utilized. Beneficiaries with at least one claim associated with SDoH Z-codes between 2016 and 2019 were identified excluding those 65+ years of age and others dually eligible for Medicare.

Results: SDoH Z-code documentation was associated with approximately 1.2 million claims for 181,136 unique beneficiaries. Females (54.3%) and Hispanics (47.9%) comprised a majority of beneficiaries with Z-code documentation, and the average age was 14.2 ± 13.4 years. Nearly 40% had Z-code documentation of "problems related to upbringing" (Z62) (N = 68,478, 37.8%), followed by "problems related to primary support group including family circumstances" (Z63) (N = 42,378, 23.4%), and "problems related to education and literacy" (Z55) (N = 28,848, 15.9%). SDoH Z-code documentation increased slightly over the years from 1% of Medicaid beneficiaries in 2016 to 1.3% in 2019.

Conclusion: A steady increase in SDoH Z-code documentation was observed among Medicaid beneficiaries but represented a relatively small proportion of the beneficiaries overall.

Keywords: Medicaid; Social determinants of health; Z-code.