Don't forget the Z Codes

Though generally a billable occurrence

the Conditions known as the Z codes 

are truly the Meat and the Potatoes

of any psychiatric visit

yet pertinant to ALL medical



They are the psychosocial stressors

that mitigate, cause, influence the presenting

or chief complaint

and as such need to be identified

especially when treatment fails to

progress conventionally.


These were the items formerly on 

Axis IV

in the DSMIII-IV formulation.


IV: Psychosocial Stressors


This was a  formulation developed by Dr. Engel(1913-1999)  that used the Biopsychosocial model that looked at the entire patient as a way of assessment.


Those  are the issues that are identified as "Z" codes.


Example of Axis I-V older formualtion 


I   Major Psychiatric Pathology

II  Personality disorder, Intellectual Disorders(formerly Mental retardation)

III Medical Diagnoses

IV  Psychosocial stressor

V   GAF Global Assessment of Function






These stressors will often avail themselves over the course of treatment or may require inquiry.


Conditions such as:      partner relationship issues 

                                  domestic violence 

                                  sexual abuse


                                  economic problems



Z codes:



sibling relational problem Z62.891

upbringing away from parents Z62.2

child affected by parental relationship Z62.820

educational Z55.9

neighbor, landlord discord Z59.2

legal issues Z65.3

access to health care Z75.9

high expressed emotion Z63.8


Other stressors:




lack of food/water Z59.4

phase of life issues Z60.0

problems with acculturation Z60.3

living alone Z60.2

social rejection/exclusion Z60.4

discrimination Z60.5

release from prison Z65.2

unwanted pregnancy Z64.0

religious problem Z53.10



Don't forget the Z codes.

They will guide you through the care of your patient and may help you to understand important factors influencing their care.







Disclaimer: Not responsible for the accuracy of the above codes.

Please check for accuracy before entering into the EHR.