ICD-10 z-codes: Possible provider utilization bias

With the presence of the Affordable Care Act (ACA) and Healthy People 2030, SDoH are at the forefront of health initiatives that have urged providers to incorporate those factors into caring for patients. ICD-10 Z-codes are one aspect that contributes to the understanding of social determinants of health representing the complexity of patients outside of treatment rooms. Multiple studies indicate that the utilization of Z-codes in practice has remained exceedingly low, typically ranging between 2-5% overall. Recent research reports that approximately two-thirds of hospitals screen for risk factors related to the social determinants of health. CMS data indicate beneficiaries with any Z-code are 75.2% White and 13.2% Black or African American. However, code Z59.0 (homelessness) is disproportionately overrepresented by Black and African American (24.8%) beneficiaries compared to White (60.9%) beneficiaries with White beneficiaries being assigned a higher number of Z-codes overall. The goal of this research is to provide an understanding of inequity that may exist in Z-code provider utilization data and possible explanations for the inequity. Policy implications may exist if there is proven inequality among provider utilization of Z-codes.