Enich Michael, Tiderington Emmy
University of Washington, Seattle, WA, USA.
School of Social Work, Rutgers University, New Brunswick, NJ, USA.
J Gen Intern Med. 2025 May 5. doi: 10.1007/s11606-025-09548-w.
Health settings are increasingly assessing and addressing health-related social needs. ICD-10 Z codes are billing codes for social determinants of health (SDOH), but represent a novel opportunity to document social needs given their ubiquity; yet they are seldom used. Little work has explored physician perspectives on the utility of Z codes for social needs documentation.
To elucidate physician understandings of Z codes and their perspectives on Z codes' utility in documenting patients' health-related social needs.
Semi-structured qualitative interviews.
Physicians at high Z-coding hospitals in New Jersey (n = 18).
Deductive and inductive thematic content and cross-case analysis.
Physicians assessed social needs. History taking and physician specialty influenced when needs were identified and documented. Needs most often came up in discharge planning. Physicians recognized their important role in ensuring social needs would be documented, but were unsure of what to do when a patient identified these needs. Physicians lacked explicit knowledge about Z codes and often would accidentally use them by "diagnosing" health-related social needs in the problem list. Hospital systems, SDOH screening, and reimbursement all influenced Z-coding; participants could not describe a systematic screening or documentation process at any hospital. Ultimately, Z codes were viewed as a tool to connote complexity and seek higher reimbursement.
Z codes are ubiquitous across electronic medical records and represent an opportunity to document health-related social needs across settings. Physicians reported using them primarily as billing codes to document complex medical planning in the context of social risk and to drive higher reimbursement. Future work could consider these codes for other initiatives, such as integrating them into screening practices or using this reimbursement to fund social health programs.
医疗机构越来越多地评估和解决与健康相关的社会需求。国际疾病分类第十版（ICD - 10）Z编码是健康社会决定因素（SDOH）的计费代码，但鉴于其普遍性，它们为记录社会需求提供了一个新机会；然而，它们很少被使用。很少有研究探讨医生对Z编码在记录社会需求方面效用的看法。
阐明医生对Z编码的理解以及他们对Z编码在记录患者与健康相关社会需求方面效用的看法。
半结构化定性访谈。
新泽西州高Z编码医院的医生（n = 18）。
演绎和归纳主题内容及跨案例分析。
医生评估社会需求。病史采集和医生专业影响需求的识别和记录时机。需求最常出现在出院计划中。医生认识到他们在确保记录社会需求方面的重要作用，但当患者提出这些需求时，不确定该怎么做。医生缺乏关于Z编码的明确知识，并且经常会在问题列表中“诊断”与健康相关的社会需求时意外使用它们。医院系统、SDOH筛查和报销都影响Z编码；参与者无法描述任何一家医院的系统筛查或记录过程。最终，Z编码被视为一种表示复杂性并寻求更高报销的工具。
Z编码在电子病历中无处不在，为跨环境记录与健康相关的社会需求提供了一个机会。医生报告主要将它们用作计费代码，以记录社会风险背景下的复杂医疗计划并推动更高的报销。未来的工作可以考虑将这些代码用于其他举措，例如将它们整合到筛查实践中，或者利用这种报销为社会健康项目提供资金。
