UMEM Educational Pearls

Since the switch from fee for service to value based care in the US, there has been a marked push to improve our documentation to expand our MDM and differential considerations.  We are all here becoming adept at the medical documentation (thanks Dr. Adler!), but may not be adequately documenting our patients' social determinants of health using the social Z codes, a subset of ICD-10 coding language

This study wanted to look at the overall prevelance of social Z code utilization.  They used the Nationwide Emergency Department Sample (NEDS), a nationwide database of ED visits, to look at this particular documentation.  They examined 35 million (!) ED visits and found that only 1.2% had any social Z code included in the documentation.  Given how many resources are linked to a verified (eg documented) need, this raises the idea that if Z codes are better documented, this may lead to increased funding for things like food, housing and transportation insecurities.

Limitations- the authors only examined the ED visits for ICD-10 codes, they didn't specifically look at the notes themselves which may have contained SDOH information.  They also found that the social Z codes were more often documented in visits coded for mental health diagnoses, potentially indicating bias.  There is also the concern that patients may not want the social z codes included, given the stigma around things like homelessness.

Overall, social Z code documentation could potentially unlock better resources for our patients by documenting a specific need in a population.  More will come as documentation continues to evolve.


Molina, MF, et al.  Social Risk Factor Documentation in Emergency Departments. Annals of Emergency Medicine, Vol 81, No. 1; January 2023.  p38-46