Z-Codes for COVID-19 and Racial Inequities
Below I give examples of how to increase the use of Z-codes with our patients as they cope with the global impact of a deadly virus and current social uprising, rallies, and protests of police brutality and death of unarmed Black men and women.
This is not an exhaustive list but rather helpful suggestions.
Problems Related to Social Environment
People of color, including immigrants, are at higher risk of acculturation and assimilation difficulties in the dominant culture. When People have different skin tones, hair textures, and accents they are more susceptible to social exclusion and rejection at work, in their own neighborhood, and at school. Additionally, people of color are often targets of overt and covert microaggressions and profiling because of discrimination, prejudice, and stereotyping. Suggested Z Code(s):
Z 60.3 acculturation difficulty
Z 60.4 social exclusion or rejection
Z60.5 target of perceived adverse discrimination or persecution
Problems Related to Crime or Interaction with the Law and Other Psychosocial, Personal, and Environmental Circumstances
Social unrest, protests, and rallies put Black and Brown people at an increased risk of unjust treatment, police brutality, and harsh sentencing and inhumane treatment (such as public hangings, viewing televised murders of Black citizens, etc.)
Z 65.4 victim of crime, terrorism or torture,
Z 65.5 exposure to disaster, war or other hostilities,
Z 65.3 problems related to other legal circumstances.
Problems Related to Education
Stress and tension have been widespread across the nation because of school and college closure due to COVID -19. High school seniors were stripped of graduation ceremonies. College students returned home to resume class virtually. Parents of primary school students had to adapt to working from home, balance work responsibilities, and manage distance learning for their small children. Suggested Z Code(s):
Z 55.1 schooling unavailable and unattainable
55.4 educational maladjustment and discord with teachers and classmates,
Z 55.2 failed school examinations,
Z 55.8 other problems related to education and literacy
Z55.9 academic and educational problems
Problems Related to Employment and Unemployment
Stress and pressure have increased among people facing employment problems including job loss, lay-off, and untimely work from home mandates. New or increased work responsibilities have impact functioning, including managing increased emails, daily video conferencing, micromanagement by supervisors, difficulty managing work/life balance, and decreased physical mobility from remote work from home. Social unrest is impacting employee morale and discord among workmates. Suggested Z Code(s):
Z 56.1 change of job
Z 56.2 threat of job loss
Z 56.3 stressful work schedule
Z 56.4 discord with both mates workmates
Z 56.5 uncongenial work environment
Z 56.6 other physical and mental strain related to work,
Z 56.8 other problems related to unemployment.
Z 56.9 other problems related to employment
Other Problems Related to Primary Support Group
Widespread loss and grief are impacting families across the nation because of the untimely deaths of loved ones who contracted COVID-19, front line workers who have to live away from family members because of the risk of spreading the disease; caretaking responsibilities to family members requiring care and recovery at home; and the fear of contracting the virus along with the stress of daily reminders of a global pandemic.
Z 63.3 absence of a family member
Z 63.4 disappearance or death of a family member
Z 63.5 disruption of the family by separation and divorce
Z 63.6 dependent relative needing care at home
Z 63.7 other stressful life events affecting family and household
Problems Related to Spouse or Partner Violence
Domestic violence is on the rise due to job closures, reduction in income, less social encounters, increased working from home, and close proximity to family members without respite.
Z 63.0 relationship distress with a spouse or intimate partner, spouse, or partner violence.
Housing and Economic Problems
Many clients are unable to pay their rent or make mortgage payments due to a significant reduction in income. As a result, discord between landlord and tenant increased. Suggested Z Code(s):
Z 59.2 discord with Neighbor, lodgers or landlord
Other Problems Related to Primary Support Group
With social distancing and self-quarantine in place, emotional tensions are running high in households across the nation. Untimely deaths and loved ones dying alone in hospitals, no final goodbyes, and virtual funerals, This code is also suitable for bereavement associated with the death of unarmed black people, imprisoned, and killed protesters. Suggested Z Code(s):
Z 63.8 high expressed emotion level within the family
Z63.4 uncomplicated bereavement.
There may be clients who exhibit conditions that are not included above. This list serves only to demonstrate and encourage the use of common and not-so-common Z-Codes. It is a resource to help mental and behavioral health clinicians validate and legitimize significant psychosocial distress observed in the people we support.
Collectively we should seek to unearth Z-codes from the bowels of the DSM-5 and legitimize their untapped power to name the pain and suffering of our clients.
Gena Golden received her bachelor’s of social work (BSW) from Temple University (1991) and master’s of social work (MSW) from Clark Atlanta University School of Social Work (1993). She is a licensed clinical social worker and owner of Inner Coach Counseling, LLC, an integrative and holistic therapy practice. Mrs. Golden is certified in hypnotherapy, clinical supervision through NASW-GA Chapter, trained in intergenerational trauma in Black families, certified neuroscience-based coach, trained in Brain Spotting Phase One, and a social and racial justice advocate. Mrs. Golden is the creator of Slay Your Inner Critic deck of cards and Grow Work Prescription Pads for Mental Health Professionals.
Barker, R. L. (2014). Social Justice. In The Social Work Dictionary (6th ed., pp. 398-399). Washington, DC, DC: NASW Press.
Bitter, M. C. (2016, April 11). Dismantling Structural Racism Through Community Building. Retrieved July 02, 2020, from https://www.aspeninstitute.org/blog-posts/dismantling-structural-racism-through-community-building/
Diangelo, R. (2018). White Fragility. In White Fragility: Why it’s’ so hard to talk to white people about racism. Boston, MA: Beacon.
Goar, E. S. (2017, May). Don’t Sleep On Z Codes. Retrieved July 02, 2020, from https://www.fortherecordmag.com/
Morrison, J. R. (2014). Diagnosis made easier: Principles and techniques for mental health clinicians. New York, NY: Guilford Press.
NASW (Ed.). (2018, January 1). Code of Ethics. Retrieved July 02, 2020, from https://www.socialworkers.org/
Narrow, W. E., MD, Peele, R., MD, Wulsin, L. R., MD, Zeanah, C. H., MD, & Fisher, P. W. (2013). Other Conditions That May Be a Focus of Clinical Attention. In Diagnostic and statistical manual of mental disorders (5TH ed., pp. 715-727). Arlington, VA: American Psychiatric Publishing.
Persons with potential health hazards related to socioeconomic and psychosocial circumstances. (n.d.). Retrieved July 02, 2020, from https://icd10coded.com/