The Ask the Analyst series is a deep dive into the data by those most familiar with the CO APCD – the analysts themselves. We’ll hear about their experiences with recent analyses and answer any pressing questions that come up. Have a question for the CIVHC Analyst Team? Email it to

Analyst Name: Megha Jha

Featured Project: Exploring Social Needs Codes in the Colorado All Payer Claims Database (CO APCD)

This analysis explored utilization of ICD-10 Z-codes to indicate the presence of social risk factors (i.e., social determinants of health) across payers and years in the Colorado All Payer Claims Database (CO APCD). The goal was to understand whether these codes were being used and how frequently.

  1. What were your first steps when beginning this analysis?

    First, I had to understand the wide variety of social risk factor Z-codes from the lists recognized by the Centers for Medicare & Medicaid Services (CMS) and the American Hospital Association (AHA). Then I had to determine whether these codes were present in the CO APCD across the years.

  2. Were there specific considerations you needed to consider based on the data?

    Z-codes were introduced during the transition from ICD-9 to ICD-10 codes in 2015. That meant the analysis would need evaluate claims from 2016 onward.

  3. What challenges did you encounter while performing the analysis? How did you overcome them?

    One of the early challenges included finding out if there were any Z-codes that might not have been included on the CMS/AHA lists. We reviewed other sources, looking for social risk factors, such as research papers and coding software from the American Academy of Professional Coders (AAPC) to pinpoint any additional codes and their definitions.

    Additionally, figuring out how to tell the story of the results of the analysis was also challenging as the low volume highlights the struggle to motivate payers or providers to use these codes.

  4. Without delving into results, did anything surprise you about this analysis or the process of executing it?

    The low volume of claims with Z-codes in CO APCD database was somewhat surprising. Providers are not using them to the fullest extent, likely due to them being fairly new, and a lack of reimbursement tied to using these codes.

  5. What did you learn while performing this analysis?

    Despite the low volume of claims with Z-codes in the CO APCD, the analysis made it clear that different types of social risk factors impact the lives of a significant number of Coloradans. Most especially, individuals are struggling with housing and economic circumstances as well as education and literacy.

    As the COVID-19 pandemic demonstrated, there are starkly different health care outcomes based on race, ethnicity, and socio-economic status. These codes are vital as they are demographics that impact health equity and further work is needed to ensure that they are better employed in the future. Encouraging providers to use these codes more regularly could help entities like CIVHC and others who are looking for ways to use data to reduce health inequities.