What Are Z Codes for Mental Health?
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Looking for a list of Z codes for mental health? Use this free Z codes list to familiarize yourself with these specifier codes for client documentation.
Z codes for mental health, previously known as V codes, are specifiers used to document a client’s mental health for accurate billing and insurance reimbursement.
This article contains a Z codes list that therapists can refer to when diagnosing clients, planning treatments, and submitting insurance claims.
Z codes for mental health are found in the International Classification of Diseases, Tenth Revision (ICD-10) and the American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). These codes allow counselors to conceptualize their clients in a more thorough way.
Z codes fall under the category, “Other conditions that may be a focus of clinical attention” in the DSM-5. This category includes matters that impact the diagnosis and treatment of a client’s mental health, and issues that are important enough to warrant clinical focus.
However, Z codes are not mental health diagnoses, but may be used in addition to a diagnosis or instead of one. These codes include social determinants of health (SDoH) information, allowing counselors to narrow down a client’s primary sources of stress.
Keep reading to learn the benefits of using Z codes for mental health and use the common Z codes list to supplement your client documentation.
Benefits of using Z codes
Since people with mental health diagnoses may face stigma, Z codes for mental health can be met with greater receptivity by clients. Additionally, they can alert insurance companies of the more detailed needs of their clients, broadening their scope of referrals.
Z codes are especially useful for child and adolescent clients who have other helpers involved in their care, such as school staff and pediatricians.
Adult clients can benefit from the inclusion of Z codes, too, particularly if their treatment includes referrals to providers in other specialties, such as psychiatrists, neurologists, or endocrinologists.
Z codes for mental health can even assist a client’s future counselors in making more accurate diagnoses and treatment plans.
For instance, upon moving to a new state and resuming therapy with a new counselor, a client may be hesitant to disclose their history of childhood abuse. However, if their referral paperwork includes the specifier Z62.810 (Personal history of physical and sexual abuse in childhood), the new counselor is made aware of this important piece of background information.
Considerations when using Z codes
In general, Z codes have been insufficiently used by counselors. This deficit is primarily due to matters of client billing and confidentiality. Because Z codes are not mental health disorders, it is uncertain whether or not insurance companies will pay for services rendered with these codes alone.
On the other hand, since F codes are widely accepted by different insurances, counselors tend to limit their diagnoses to these codes alone and do not add supplemental Z codes.
Z codes are also quite explicit in their explanation of a client’s struggles. For example, consider the codes Z64.0 (Problems related to unwanted pregnancy) or Z62.21 (Child in welfare custody) compared to the more generalized diagnosis F43.20 (Adjustment disorder, unspecified).
Because of their phrasing, these codes make a client’s reasons for treatment more overt, which can make counselors wary of oversharing information about their clients.
How to use Z codes for mental health
If you decide to use Z codes, first identify the category in which your client’s stress has originated or is maintained.
Evaluate details of the client’s stressors, such as the timeframe (past/present), individuals involved (family/employer), and environments (housing/workplace/school).
If there are multiple stressors, list them in order of their influence in your assessment documentation.
Because clients often present to counseling with stress related to family problems, make sure to familiarize yourself with the Z codes for family problems: sections Z62 (Problems related to upbringing) and Z63 (Other problems related to primary support group, including family circumstances).
These codes include matters with which counselors are familiar, like reports of abuse and neglect, as well as those less commonly encountered, such as parental overprotection and disappearance of a family member.
Since Z codes are not mental health disorders, depending on your client’s insurance policy, their presence alone may result in a rejected claim. Thus, it is best to keep an F code as the primary diagnosis and add Z codes as supplements when billing insurance.
For example, if you’re looking for a Z code for depression supplementation, a client with depressive symptoms that result in their failure to regularly attend their college classes and job could receive the following diagnosis for insurance billing purposes:
- F32.9 (Major depressive disorder, single episode, unspecified)
- Z55.3 (Underachievement in school)
- Z56.2 (Threat of job loss)
Common Z codes for mental health
A comprehensive Z codes list can be found in the ICD-10 and DSM-5-TR.
Some of the most applicable Z codes are listed below and in the Z codes for mental health PDF:
Problems Related to Education & Literacy (Z55)
- Z55.0: Illiteracy and low-level literacy
- Z55.1: Schooling unavailable and unattainable
- Z55.2: Failed school examinations
- Z55.3: Underachievement in school
- Z55.4: Educational maladjustment and discord with teachers and classmates
- Z55.8: Other problems related to education and literacy
- Z55.9: Problems related to education and literacy, unspecified
Problems Related to Employment & Unemployment (Z56)
- Z56.0: Unemployment, unspecified
- Z56.1: Change of job
- Z56.2: Threat of job loss
- Z56.3: Stressful work schedule
- Z56.4: Discord with boss and workmates
- Z56.5: Uncongenial work environment
- Z56.6: Other physical and mental strain related to work
- Z56.89: Other problems related to employment
- Z56.9: Unspecified problems related to employment
Problems Related to Housing & Economic Circumstances (Z59)
- Z59.0: Homelessness
- Z59.1: Inadequate housing
- Z59.2: Discord with neighbors, lodgers and landlord
- Z59.3: Problems related to living in residential institution
- Z59.4: Lack of adequate food and safe drinking water
- Z59.5: Extreme poverty
- Z59.6: Low income
- Z59.7: Insufficient social insurance and welfare support
- Z59.8: Other problems related to housing and economic circumstances
- Z59.9: Problem related to housing and economic circumstances, unspecified
Problems Related to Social Environment (Z60)
- Z60.0: Problems of adjustment to life-cycle transitions
- Z60.2: Problems related to living alone
- Z60.3: Acculturation difficulty
- Z60.4: Social exclusion and rejection
- Z60.5:Target of (perceived) adverse discrimination and persecution
- Z60.8: Other problems related to social environment
- Z60.9: Problems related to social environment, unspecified
Problems Related to Upbringing (Z62)
- Z62.0: Inadequate parental supervision and control
- Z62.1: Parental overprotection
- Z62.2: Upbringing away from parents
- Z62.21: Child in welfare custody
- Z62.22: Institutional upbringing
- Z62.3: Hostility towards and scapegoating of child
- Z62.6: Inappropriate (excessive) parental pressure
- Z62.810: Personal history of physical and sexual abuse in childhood
- Z62.811: Personal history of psychological abuse in childhood
- Z62.812: Personal history of neglect in childhood
- Z62.819: Personal history of unspecified abuse in childhood
- Z62.82: Parent-child conflict
- Z62.822: Parent-foster child conflict
- Z62.891: Sibling rivalry
- Z62.898: Other specified problems related to upbringing
Other Problems Related to Primary Support Group, Including Family Circumstances (Z63)
- Z63.0: Problems in relationship with spouse or partner
- Z63.3: Absence of family member
- Z63.4: Disappearance and death of family member
- Z63.5: Disruption of family by separation and divorce
- Z63.6: Dependent relative needing care at home
- Z63.7: Other stressful life events affecting family and household
- Z63.72: Alcoholism and drug addiction in family
- Z63.8: Other specified problems related to primary support group
Problems Related to Certain Psychosocial Circumstances (Z64)
- Z64.0: Problems related to unwanted pregnancy
- Z64.1: Problems related to multiparity
- Z64.4: Discord with counselors
Problems Related to Other Psychosocial Circumstances (Z65)
- Z65.0: Conviction in civil and criminal proceedings without imprisonment
- Z65.1: Imprisonment and other incarceration
- Z65.2: Problems related to release from prison
- Z65.3: Problems related to other legal circumstances
- Z65.4: Victim of crime and terrorism
- Z65.5: Exposure to disaster, war, and other hostilities
- Z65.8: Other specified problems related to psychosocial circumstances
Problems Related to Medical Facilities and Other Health Care (Z75)
- Z75.3: Unavailability and inaccessibility of health care facilities
- Z75.4: Unavailability and inaccessibility of other helping agencies
Deciding to use Z codes
The choice to use Z codes is unique to every counselor. Z codes for mental health allow for more wide-ranging case conceptualization and can reduce stigma.
However, Z codes have less consistent coverage by insurance companies and make clients’ reasons for treatment more visible. Therefore, take your time to carefully review the Z codes list and weigh the benefits and consequences of using Z codes with your clients.
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