339 - A Carolinas Collaborative Quality Improvement Project to Increase ICD-10 Coding for Food Insecurity

Poster Number: 339
Publication Number: 339.345

Kimberly Montez, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, WINSTON-SALEM, NC, United States; Carolyn Avery, Duke, Durham, NC, United States; Debra Best, Duke University School of Medicine, Durham, NC, United States; Meredith Eicken, University of South Carolina School of Medicine Greenville, Greenville, SC, United States; Shivani Mehta, Atrium Health, Charlotte, NC, United States; Kerry Sease, University of South Carolina School of Medicine Greenville, Greenville, SC, United States; Jane B. Amati, University of South Carolina School of Medicine Greenville, Greenville, SC, United States

Background: Pediatricians are increasingly screening and intervening for food insecurity (FI). Documenting FI in the electronic health record (EHR) via International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) could have important implications for health care delivery, including social resource allocation, risk prediction, population health strategies and performance-based incentives. However, little data on utilization of ICD-10 codes for FI exist in the pediatric literature.

Objective: The aim of this quality improvement (QI) project was to document an FI ICD-10 code (Z59.4 Lack of adequate food) in 80% of charts that had a positive FI screen over a 10-month period.

Design/Methods: This QI study was part of a larger project to implement FI screening and referral at 8 pediatric academic clinics in North and South Carolina through the Carolinas Collaborative. Plan-Do-Study-Act (PDSA) cycles were tailored to each clinical site and included clinician education and training, reminder presentations and materials, adding FI screening questions to note templates, and implementing a best practice advisory to add Z59.4 to the visit diagnoses. Thirty chart audits were completed monthly by each site with de-identified data entered into the American Academy of Pediatrics Quality Improvement Data Aggregating database. Baseline data were established in 12/2020, and intervention data were collected from 1/2021–11/2021. Process measure was proportion screened and for FI and outcome measure was the proportion of positive screens with a documented Z59.4 code.

Results: 2380 charts were reviewed across 8 institutions over 11 months; 282 (11.8%) were identified as having FI; 240 of those with FI received a referral (85.1%). The demographics of those who screened positive are listed in Table 1. The majority of participants who screened positive identified as “Other” race (57%), Hispanic ethnicity (67%), and as having public insurance (88%). FI screening rates improved from 68% to 85% (Figure 1). Documentation of positive FI screen with an ICD-10 code improved from 39% to 47% (Figure 2).Conclusion(s): FI screening and documentation rates increased after several interventions across 8 pediatric academic clinics. Although we have not yet reached our ICD-10 diagnosis documentation goal of 80%, future PDSA cycles will focus on increasing documentation rates through provider education, addressing barriers to coding and documentation, and EHR innovation.
Table 1Demographic Characteristics of Participants Screening Positive for Food Insecurity
Figure 2Run Chart for Proportion of Participants Screened for Food Insecurity