Table 1.

Selection of Existing and Proposed Z Codes for Various Categories of Social Determinants of Health

ICD-10-CM Z code categories	Sample of existing Z codes	Proposed Z codes*
Z55 Education and literacy	Illiteracy/low-level literacy School unavailable/unattainable Underachievement in school	Less than a high school degree Limited English proficiency Low health literacy
Z56 Employment	Unemployment Threat of job loss Stressful work schedule	Unemployed, seeking work Unemployed, not seeking work Employed part time or temporary On permanent disability
Z57 Occupational exposures	Noise Tobacco smoke Toxic agents	Ergonomic/physical stress Repetitive motion
Z59 Housing and economic	Homelessness Inadequate housing Discord with neighbors/landlord Residential institution problems Lack of adequate food/water Inadequate welfare support Extreme poverty Low income Insufficient welfare support	Unsafe neighborhood / housing Food insecurity Living in food desert Inadequate nutritious food choices Inadequate drinking water supply Lack of physical activity opportunities Extensive debt At risk of bankruptcy Unable to afford: Prescriptions; Medical expenses; Phone; Utilities; Transportation; Clothing; Childcare
Z60 Social environment	Acculturation difficulty Social exclusion Target of adverse discrimination	Unable to deal with stress Feeling unsafe in social environment Can hardly count on family/friends Inadequate social interaction
Z62 Upbringing	Inadequate parental supervision Parental abuse or neglect
Z63 Support group / family	Family conflict Death of a family member Addiction in family Dependent relative needing care	Chronic social/environmental stressors Inadequate caregiver needs Providing fulltime care for loved one Providing hospice care for loved one
Z64 Psychosocial circumstances	Unwanted pregnancy Discord with counselors
Z65 Other psychosocial	Imprisonment/Incarceration Conviction of crime Victim of crime	Victim of interpersonal violence Trauma relating to refugee status

*Several of these are adapted from proposals at the March 5–6, 2019, ICD-10 Coordination and Maintenance Committee Meeting (pages 45–46 and 21–22),⁶ while others are the author’s own suggestions