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DSMII.docxOther Conditions That May Be
a Focus of Clinical Attention
This discussion covers other conditions and problems that may be a focus of clinical
attention or that may otherwise affect the diagnosis, course, prognosis, or treatment of
a patient’s mental disorder. These conditions are presented with their corresponding
codes from ICD-9-CM (usually V codes) and ICD-10-CM (usually Z codes). A condition
or problem in this chapter may be coded if it is a reason for the current visit or helps to
explain the need for a test, procedure, or treatment. Conditions and problems in this chapter
may also be included in the medical record as useful information on circumstances that
may affect the patient’s care, regardless of their relevance to the current visit.
The conditions and problems listed in this chapter are not mental disorders. Their inclusion
in DSM-5 is meant to draw attention to the scope of additional issues that may be
encountered in routine clinical practice and to provide a systematic listing that may be
useful to clinicians in documenting these issues.
Relational Problems
Key relationships, especially intimate adult partner relationships and parent/caregiverchild
relationships, have a significant impact on the health of the individuals in these relationships.
These relationships can be health promoting and protective, neutral, or detrimental
to health outcomes. In the extreme, these close relationships can be associated with
maltreatment or neglect, which has significant medical and psychological consequences
for the affected individual. A relational problem may come to clinical attention either as
the reason that the individual seeks health care or as a problem that affects the course,
prognosis, or treatment of the individual’s mental or other medical disorder.
Problems Related to Family Upbringing
V61.20 (Z62.820) Parent-Child Relational Problem
For this category, the term parent is used to refer to one of the child’s primary caregivers,
who may be a biological, adoptive, or foster parent or may be another relative (such as a
grandparent) who fulfills a parental role for the child. This category should be used when
the main focus of clinical attention is to address the quality of the parent-child relationship
or when the quality of the parent-child relationship is affecting the course, prognosis, or
treatment of a mental or other medical disorder. Typically, the parent-child relational
problem is associated with impaired functioning in behavioral, cognitive, or affective domains.
Examples of behavioral problems include inadequate parental control, supervision,
and involvement with the child; parental overprotection; excessive parental pressure; arguments
that escalate to threats of physical violence; and avoidance without resolution of
problems. Cognitive problems may include negative attributions of the other’s intentions,
hostility toward or scapegoating of the other, and unwarranted feelings of estrangement.
Affective problems may include feelings of sadness, apathy, or anger about the other individual
in the relationship. Clinicians should take into account the developmental needs
of the child and the cultural context.
V61.8 (Z62.891) Sibling Relational Problem
This category should be used when the focus of clinical attention is a pattern of interaction
among siblings that is associated with significant impairment in individual or family functioning
or with development of symptoms in one or more of the siblings, or when a sibling relational
problem is affecting the course, prognosis, or treatment of a sibling’s mental or other medical
disorder. This category can be used for either children or adults if the focus is on the sibling relationship.
Siblings in this context include full, half-, step-, foster, and adopted siblings.
V61.8 (Z62.29) Upbringing Away From Parents
This category should be used when the main focus of clinical attention pertains to issues
regarding a child being raised away from the parents or when this separate upbringing affects
the course, prognosis, or treatment of a mental or other medical disorder. The child
could be one who is under state custody and placed in kin care or foster care. The child
could also be one who is living in a nonparental relative’s home, or with friends, but whose
out-of-home placement is not mandated or sanctioned by the courts. Problems related to a
child living in a group home or orphanage are also included. This category excludes issues
related to V60.6 (Z59.3) children in boarding schools.
V61.29 (Z62.898) Child Affected by Parental Relationship Distress
This category should be used when the focus of clinical attention is the negative effects of
parental relationship discord (e.g., high levels of conflict, distress, or disparagement) on a
child in the family, including effects on the child’s mental or other medical disorders.
Other Problems Related to Primary Support Group
V61.10 (Z63.0) Relationship Distress With Spouse or Intimate Partner
This category should be used when the major focus of the clinical contact is to address the
quality of the intimate (spouse or partner) relationship or when the quality of that relationship
is affecting the course, prognosis, or treatment of a mental or other medical disorder.
Partners can be of the same or different genders. Typically, the relationship distress
is associated with impaired functioning in behavioral, cognitive, or affective domains. Examples
of behavioral problems include conflict resolution difficulty, withdrawal, and
overinvolvement. Cognitive problems can manifest as chronic negative attributions of the
other’s intentions or dismissals of the partner’s positive behaviors. Affective problems
would include chronic sadness, apathy, and/or anger about the other partner.
Note: This category excludes clinical encounters for V61.1x (Z69.1x) mental health services
for spousal or partner abuse problems and V65.49 (Z70.9) sex counseling.
V61.03 (Z63.5) Disruption of Family by Separation or Divorce
This category should be used when partners in an intimate adult couple are living apart
due to relationship problems or are in the process of divorce.
V61.8 (Z63.8) High Expressed Emotion Level Within Family
Expressed emotion is a construct used as a qualitative measure of the “amount” of emotion—
in particular, hostility, emotional overinvolvement, and criticism directed toward a
family member who is an identified patient—displayed in the family environment. This
category should be used when a family’s high level of expressed emotion is the focus of
clinical attention or is affecting the course, prognosis, or treatment of a family member’s
mental or other medical disorder.
V62.82 (Z63.4) Uncomplicated Bereavement
This category can be used when the focus of clinical attention is a normal reaction to the
death of a loved one. As part of their reaction to such a loss, some grieving individuals
present with symptoms characteristic of a major depressive episode—for example, feelings of sadness and associated symptoms such as insomnia, poor appetite, and weight
loss. The bereaved individual typically regards the depressed mood as “normal,” although
the individual may seek professional help for relief of associated symptoms such
as insomnia or anorexia. The duration and expression of “normal” bereavement vary considerably
among different cultural groups. Further guidance in distinguishing grief from
a major depressive episode is provided in the criteria for major depressive episode.
Abuse and Neglect
Maltreatment by a family member (e.g., caregiver, intimate adult partner) or by a nonrelative
can be the area of current clinical focus, or such maltreatment can be an important
factor in the assessment and treatment of patients with mental or other medical disorders.
Because of the legal implications of abuse and neglect, care should be used in assessing
these conditions and assigning these codes. Having a past history of abuse or neglect can
influence diagnosis and treatment response in a number of mental disorders, and may also
be noted along with the diagnosis.
For the following categories, in addition to listings of the confirmed or suspected event
of abuse or neglect, other codes are provided for use if the current clinical encounter is to
provide mental health services to either the victim or the perpetrator of the abuse or neglect.
A separate code is also provided for designating a past history of abuse or neglect.
Coding Note for ICD-10-CM Abuse and Neglect Conditions
For T codes only, the 7th character should be coded as follows:
A (initial encounter)— Use while the patient is receiving active treatment for
the condition (e.g., surgical treatment, emergency department encounter, evaluation
and treatment by a new clinician); or
D (subsequent encounter)— Use for encounters after the patient has received
active treatment for the condition and when he or she is receiving routine care
for the condition during the healing or recovery phase (e.g., cast change or removal,
removal of external or internal fixation device, medication adjustment,
other aftercare and follow-up visits).
Child Maltreatment and Neglect Problems
Child Physical Abuse
Child physical abuse is nonaccidental physical injury to a child—ranging from minor bruises
to severe fractures or death—occurring as a result of punching, beating, kicking, biting,
shaking, throwing, stabbing, choking, hitting (with a hand, stick, strap, or other object),
burning, or any other method that is inflicted by a parent, caregiver, or other individual who
has responsibility for the child. Such injury is considered abuse regardless of whether the
caregiver intended to hurt the child. Physical discipline, such as spanking or paddling, is not
considered abuse as long as it is reasonable and causes no bodily injury to the child.
Child Physical Abuse, Confirmed
995.54 (T74.12XA) Initial encounter
995.54 (T74.12XD) Subsequent encounter
Child Physical Abuse, Suspected
995.54 (T76.12XA) Initial encounter
995.54 (T76.12XD) Subsequent encounter
Other Circumstances Related to Child Physical Abuse
V61.21 (Z69.010) Encounter for mental health services for victim of child abuse by parent
V61.21 (Z69.020) Encounter for mental health services for victim of nonparental child
abuse
V15.41 (Z62.810) Personal history (past history) of physical abuse in childhood
V61.22 (Z69.011) Encounter for mental health services for perpetrator of parental child
abuse
V62.83 (Z69.021) Encounter for mental health services for perpetrator of nonparental
child abuse
Child Sexual Abuse
Child sexual abuse encompasses any sexual act involving a child that is intended to provide
sexual gratification to a parent, caregiver, or other individual who has responsibility
for the child. Sexual abuse includes activities such as fondling a child’s genitals, penetration,
incest, rape, sodomy, and indecent exposure. Sexual abuse also includes noncontact
exploitation of a child by a parent or caregiver—for example, forcing, tricking, enticing,
threatening, or pressuring a child to participate in acts for the sexual gratification of others,
without direct physical contact between child and abuser.
Child Sexual Abuse, Confirmed
995.53 (T74.22XA) Initial encounter
995.53 (T74.22XD) Subsequent encounter
Child Sexual Abuse, Suspected
995.53 (T76.22XA) Initial encounter
995.53 (T76.22XD) Subsequent encounter
Other Circumstances Related to Child Sexual Abuse
V61.21 (Z69.010) Encounter for mental health services for victim of child sexual abuse
by parent
V61.21 (Z69.020) Encounter for mental health services for victim of nonparental child
sexual abuse
V15.41 (Z62.810) Personal history (past history) of sexual abuse in childhood
V61.22 (Z69.011) Encounter for mental health services for perpetrator of parental child
sexual abuse
V62.83 (Z69.021) Encounter for mental health services for perpetrator of nonparental
child sexual abuse
Child Neglect
Child neglect is defined as any confirmed or suspected egregious act or omission by a
child’s parent or other caregiver that deprives the child of basic age-appropriate needs and
thereby results, or has reasonable potential to result, in physical or psychological harm to
the child. Child neglect encompasses abandonment; lack of appropriate supervision; failure
to attend to necessary emotional or psychological needs; and failure to provide necessary
education, medical care, nourishment, shelter, and/or clothing.
Child Neglect, Confirmed
995.52 (T74.02XA) Initial encounter
995.52 (T74.02XD) Subsequent encounter
Child Neglect, Suspected
995.52 (T76.02XA) Initial encounter
995.52 (T76.02XD) Subsequent encounter
Other Circumstances Related to Child Neglect
V61.21 (Z69.010) Encounter for mental health services for victim of child neglect by
parent
V61.21 (Z69.020) Encounter for mental health services for victim of nonparental child
neglect
V15.42 (Z62.812) Personal history (past history) of neglect in childhood
V61.22 (Z69.011) Encounter for mental health services for perpetrator of parental child
neglect
V62.83 (Z69.021) Encounter for mental health services for perpetrator of nonparental
child neglect
Child Psychological Abuse
Child psychological abuse is nonaccidental verbal or symbolic acts by a child’s parent or
caregiver that result, or have reasonable potential to result, in significant psychological
harm to the child. (Physical and sexual abusive acts are not included in this category.) Examples
of psychological abuse of a child include berating, disparaging, or humiliating
the child; threatening the child; harming/abandoning—or indicating that the alleged
offender will harm/abandon—people or things that the child cares about; confining the
child (as by tying a child’s arms or legs together or binding a child to furniture or another
object, or confining a child to a small enclosed area [e.g., a closet]); egregious scapegoating
of the child; coercing the child to inflict pain on himself or herself; and disciplining the
child excessively (i.e., at an extremely high frequency or duration, even if not at a level of
physical abuse) through physical or nonphysical means.
Child Psychological Abuse, Confirmed
995.51 (T74.32XA) Initial encounter
995.51 (T74.32XD) Subsequent encounter
Child Psychological Abuse, Suspected
995.51 (T76.32XA) Initial encounter
995.51 (T76.32XD) Subsequent encounter
Other Circumstances Related to Child Psychological Abuse
V61.21 (Z69.010) Encounter for mental health services for victim of child psychological
abuse by parent
V61.21 (Z69.020) Encounter for mental health services for victim of nonparental child
psychological abuse
V15.42 (Z62.811) Personal history (past history) of psychological abuse in childhood
V61.22 (Z69.011) Encounter for mental health services for perpetrator of parental child
psychological abuse
V62.83 (Z69.021) Encounter for mental health services for perpetrator of nonparental
child psychological abuse
Adult Maltreatment and Neglect Problems
Spouse or Partner Violence, Physical
This category should be used when nonaccidental acts of physical force that result, or have
reasonable potential to result, in physical harm to an intimate partner or that evoke significant
fear in the partner have occurred during the past year. Nonaccidental acts of physical
force include shoving, slapping, hair pulling, pinching, restraining, shaking, throwing,
biting, kicking, hitting with the fist or an object, burning, poisoning, applying force to the
throat, cutting off the air supply, holding the head under water, and using a weapon. Acts
for the purpose of physically protecting oneself or one’s partner are excluded.
Spouse or Partner Violence, Physical, Confirmed
995.81 (T74.11XA) Initial encounter
995.81 (T74.11XD) Subsequent encounter
Spouse or Partner Violence, Physical, Suspected
995.81 (T76.11XA) Initial encounter
995.81 (T76.11XD) Subsequent encounter
Other Circumstances Related to Spouse or Partner Violence, Physical
V61.11 (Z69.11) Encounter for mental health services for victim of spouse or partner
violence, physical
V15.41 (Z91.410) Personal history (past history) of spouse or partner violence, physical
V61.12 (Z69.12) Encounter for mental health services for perpetrator of spouse or
partner violence, physical
Spouse or Partner Violence, Sexual
This category should be used when forced or coerced sexual acts with an intimate partner
have occurred during the past year. Sexual violence may involve the use of physical force
or psychological coercion to compel the partner to engage in a sexual act against his or her
will, whether or not the act is completed. Also included in this category are sexual acts
with an intimate partner who is unable to consent.
Spouse or Partner Violence, Sexual, Confirmed
995.83 (T74.21XA) Initial encounter
995.83 (T74.21XD) Subsequent encounter
Spouse or Partner Violence, Sexual, Suspected
995.83 (T76.21XA) Initial encounter
995.83 (T76.21XD) Subsequent encounter
Other Circumstances Related to Spouse or Partner Violence, Sexual
V61.11 (Z69.81) Encounter for mental health services for victim of spouse or partner
violence, sexual
V15.41 (Z91.410) Personal history (past history) of spouse or partner violence, sexual
V61.12 (Z69.12) Encounter for mental health services for perpetrator of spouse or
partner violence, sexual
Spouse or Partner Neglect
Partner neglect is any egregious act or omission in the past year by one partner that deprives
a dependent partner of basic needs and thereby results, or has reasonable potential
to result, in physical or psychological harm to the dependent partner. This category is used
in the context of relationships in which one partner is extremely dependent on the other
partner for care or for assistance in navigating ordinary daily activities—for example, a
partner who is incapable of self-care owing to substantial physical, psychological/intellectual,
or cultural limitations (e.g., inability to communicate with others and manage everyday
activities due to living in a foreign culture).
Spouse or Partner Neglect, Confirmed
995.85 (T74.01XA) Initial encounter
995.85 (T74.01XD) Subsequent encounter
Spouse or Partner Neglect, Suspected
995.85 (T76.01XA) Initial encounter
995.85 (T76.01XD) Subsequent encounter
Other Circumstances Related to Spouse or Partner Neglect
V61.11 (Z69.11) Encounter for mental health services for victim of spouse or partner
neglect
V15.42 (Z91.412) Personal history (past history) of spouse or partner neglect
V61.12 (Z69.12) Encounter for mental health services for perpetrator of spouse or
partner neglect
Spouse or Partner Abuse, Psychological
Partner psychological abuse encompasses nonaccidental verbal or symbolic acts by one
partner that result, or have reasonable potential to result, in significant harm to the other
partner. This category should be used when such psychological abuse has occurred during
the past year. Acts of psychological abuse include berating or humiliating the victim; interrogating
the victim; restricting the victim’s ability to come and go freely; obstructing the victim’s
access to assistance (e.g., law enforcement; legal, protective, or medical resources);
threatening the victim with physical harm or sexual assault; harming, or threatening to
harm, people or things that the victim cares about; unwarranted restriction of the victim’s access
to or use of economic resources; isolating the victim from family, friends, or social support
resources; stalking the victim; and trying to make the victim think that he or she is crazy.
Spouse or Partner Abuse, Psychological, Confirmed
995.82 (T74.31XA) Initial encounter
995.82 (T74.31XD) Subsequent encounter
Spouse or Partner Abuse, Psychological, Suspected
995.82 (T76.31XA) Initial encounter
995.82 (T76.31XD) Subsequent encounter
Other Circumstances Related to Spouse or Partner Abuse, Psychological
V61.11 (Z69.11) Encounter for mental health services for victim of spouse or partner
psychological abuse
V15.42 (Z91.411) Personal history (past history) of spouse or partner psychological abuse
V61.12 (Z69.12) Encounter for mental health services for perpetrator of spouse or partner
psychological abuse
Adult Abuse by Nonspouse or Nonpartner
These categories should be used when an adult has been abused by another adult who is
not an intimate partner. Such maltreatment may involve acts of physical, sexual, or emotional
abuse. Examples of adult abuse include nonaccidental acts of physical force (e.g.,
pushing/shoving, scratching, slapping, throwing something that could hurt, punching,
biting) that have resulted—or have reasonable potential to result—in physical harm or
have caused significant fear; forced or coerced sexual acts; and verbal or symbolic acts
with the potential to cause psychological harm (e.g., berating or humiliating the person;
interrogating the person; restricting the person’s ability to come and go freely; obstructing
the person’s access to assistance; threatening the person; harming or threatening to harm
people or things that the person cares about; restricting the person’s access to or use of economic
resources; isolating the person from family, friends, or social support resources;
stalking the person; trying to make the person think that he or she is crazy). Acts for the
purpose of physically protecting oneself or the other person are excluded.
Adult Physical Abuse by Nonspouse or Nonpartner, Confirmed
995.81 (T74.11XA) Initial encounter
995.81 (T74.11XD) Subsequent encounter
Adult Physical Abuse by Nonspouse or Nonpartner, Suspected
995.81 (T76.11XA) Initial encounter
995.81 (T76.11XD) Subsequent encounter
Adult Sexual Abuse by Nonspouse or Nonpartner, Confirmed
995.83 (T74.21XA) Initial encounter
995.83 (T74.21XD) Subsequent encounter
Adult Sexual Abuse by Nonspouse or Nonpartner, Suspected
995.83 (T76.21XA) Initial encounter
995.83 (T76.21XD) Subsequent encounter
Adult Psychological Abuse by Nonspouse or Nonpartner, Confirmed
995.82 (T74.31XA) Initial encounter
995.82 (T74.31XD) Subsequent encounter
Adult Psychological Abuse by Nonspouse or Nonpartner, Suspected
995.82 (T76.31XA) Initial encounter
995.82 (T76.31XD) Subsequent encounter
Other Circumstances Related to Adult Abuse by Nonspouse or Nonpartner
V65.49 (Z69.81) Encounter for mental health services for victim of nonspousal or nonpartner
adult abuse
V62.83 (Z69.82) Encounter for mental health services for perpetrator of nonspousal or
nonpartner adult abuse
Educational and Occupational Problems
Educational Problems
V62.3 (Z55.9) Academic or Educational Problem
This category should be used when an academic or educational problem is the focus of
clinical attention or has an impact on the individual’s diagnosis, treatment, or prognosis.
Problems to be considered include illiteracy or low-level literacy; lack of access to schooling
owing to unavailability or unattainability; problems with academic performance (e.g.,
failing school examinations, receiving failing marks or grades) or underachievement (below
what would be expected given the individual’s intellectual capacity); discord with
teachers, school staff, or other students; and any other problems related to education and/
or literacy.
Occupational Problems
V62.21 (Z56.82) Problem Related to Current Military Deployment Status
This category should be used when an occupational problem directly related to an individual’s
military deployment status is the focus of clinical attention or has an impact on the
individual’s diagnosis, treatment, or prognosis. Psychological reactions to deployment are
not included in this category; such reactions would be better captured as an adjustment
disorder or another mental disorder.
V62.29 (Z56.9) Other Problem Related to Employment
This category should be used when an occupational problem is the focus of clinical attention
or has an impact on the individual’s treatment or prognosis. Areas to be considered
include problems with employment or in the work environment, including unemployment;
recent change of job; threat of job loss; job dissatisfaction; stressful work schedule;
uncertainty about career choices; sexual harassment on the job; other discord with boss,
supervisor, co-workers, or others in the work environment; uncongenial or hostile work
environments; other psychosocial stressors related to work; and any other problems related
to employment and/or occupation.
Housing and Economic Problems
Housing Problems
V60.0 (Z59.0) Homelessness
This category should be used when lack of a regular dwelling or living quarters has an impact
on an individual’s treatment or prognosis. An individual is considered to be homeless
if his or her primary nighttime residence is a homeless shelter, a warming shelter, a domestic
violence shelter, a public space (e.g., tunnel, transportation station, mall), a building
not intended for residential use (e.g., abandoned structure, unused factory), a
cardboard box or cave, or some other ad hoc housing situation.
V60.1 (Z59.1) Inadequate Housing
This category should be used when lack of adequate housing has an impact on an individual’s
treatment or prognosis. Examples of inadequate housing conditions include lack of
heat (in cold temperatures) or electricity, infestation by insects or rodents, inadequate
plumbing and toilet facilities, overcrowding, lack of adequate sleeping space, and excessive
noise. It is important to consider cultural norms before assigning this category.
V60.89 (Z59.2) Discord With Neighbor, Lodger, or Landlord
This category should be used when discord with neighbors, lodgers, or a landlord is a focus
of clinical attention or has an impact on the individual’s treatment or prognosis.
V60.6 (Z59.3) Problem Related to Living in a Residential Institution
This category should be used when a problem (or problems) related to living in a residential
institution is a focus of clinical attention or has an impact on the individual’s treatment
or prognosis. Psychological reactions to a change in living situation are not included in this
category; such reactions would be better captured as an adjustment disorder.
Economic Problems
V60.2 (Z59.4) Lack of Adequate Food or Safe Drinking Water
V60.2 (Z59.5) Extreme Poverty
V60.2 (Z59.6) Low Income
V60.2 (Z59.7) Insufficient Social Insurance or Welfare Support
This category should be used for individuals who meet eligibility criteria for social or welfare
support but are not receiving such support, who receive support that is insufficient to
address their needs, or who otherwise lack access to needed insurance or support programs.
Examples include inability to qualify for welfare support owing to lack of proper
documentation or evidence of address, inability to obtain adequate health insurance because
of age or a preexisting condition, and denial of support owing to excessively stringent
income or other requirements.
V60.9 (Z59.9) Unspecified Housing or Economic Problem
This category should be used when there is a problem related to housing or economic circumstances
other than as specified above.
Other Problems Related to the Social Environment
V62.89 (Z60.0) Phase of Life Problem
This category should be used when a problem adjusting to a life-cycle transition (a particular
developmental phase) is the focus of clinical attention or has an impact on the individual’s
treatment or prognosis. Examples of such transitions include entering or
completing school, leaving parental control, getting married, starting a new career, becoming
a parent, adjusting to an “empty nest” after children leave home, and retiring.
V60.3 (Z60.2) Problem Related to Living Alone
This category should be used when a problem associated with living alone is the focus of
clinical attention or has an impact on the individual’s treatment or prognosis. Examples of
such problems include chronic feelings of loneliness, isolation, and lack of structure in carrying
out activities of daily living (e.g., irregular meal and sleep schedules, inconsistent
performance of home maintenance chores).
V62.4 (Z60.3) Acculturation Difficulty
This category should be used when difficulty in adjusting to a new culture (e.g., following
migration) is the focus of clinical attention or has an impact on the individual’s treatment
or prognosis.
V62.4 (Z60.4) Social Exclusion or Rejection
This category should be used when there is an imbalance of social power such that there is
recurrent social exclusion or rejection by others. Examples of social rejection include bullying,
teasing, and intimidation by others; being targeted by others for verbal abuse and
humiliation; and being purposefully excluded from the activities of peers, workmates, or
others in one’s social environment.
V62.4 (Z60.5) Target of (Perceived) Adverse Discrimination or Persecution
This category should be used when there is perceived or experienced discrimination
against or persecution of the individual based on his or her membership (or perceived membership) in a specific category. Typically, such categories include gender or gender
identity, race, ethnicity, religion, sexual orientation, country of origin, political beliefs, disability
status, caste, social status, weight, and physical appearance.
V62.9 (Z60.9) Unspecified Problem Related to Social Environment
This category should be used when there is a problem related to the individual’s social environment
other than as specified above.
Problems Related to Crime or Interaction
With the Legal System
V62.89 (Z65.4) Victim of Crime
V62.5 (Z65.0) Conviction in Civil or Criminal Proceedings Without Imprisonment
V62.5 (Z65.1) Imprisonment or Other Incarceration
V62.5 (Z65.2) Problems Related to Release From Prison
V62.5 (Z65.3) Problems Related to Other Legal Circumstances
Other Health Service Encounters for
Counseling and Medical Advice
V65.49 (Z70.9) Sex Counseling
This category should be used when the individual seeks counseling related to sex education,
sexual behavior, sexual orientation, sexual attitudes (embarrassment, timidity), others’
sexual behavior or orientation (e.g., spouse, partner, child), sexual enjoyment, or any
other sex-related issue.
V65.40 (Z71.9) Other Counseling or Consultation
This category should be used when counseling is provided or advice/consultation is
sought for a problem that is not specified above or elsewhere in this chapter. Examples include
spiritual or religious counseling, dietary counseling, and counseling on nicotine use.
Problems Related to Other Psychosocial, Personal,
and Environmental Circumstances
V62.89 (Z65.8) Religious or Spiritual Problem
This category can be used when the focus of clinical attention is a religious or spiritual
problem. Examples include distressing experiences that involve loss or questioning of
faith, problems associated with conversion to a new faith, or questioning of spiritual values
that may not necessarily be related to an organized church or religious institution.
V61.7 (Z64.0) Problems Related to Unwanted Pregnancy
V61.5 (Z64.1) Problems Related to Multiparity
V62.89 (Z64.4) Discord With Social Service Provider, Including Probation Officer,
Case Manager, or Social Services Worker
V62.89 (Z65.4) Victim of Terrorism or Torture
V62.22 (Z65.5) Exposure to Disaster, War, or Other Hostilities
V62.89 (Z65.8) Other Problem Related to Psychosocial Circumstances
V62.9 (Z65.9) Unspecified Problem Related to Unspecified Psychosocial Circumstances
Other Circumstances of Personal History
V15.49 (Z91.49) Other Personal History of Psychological Trauma
V15.59 (Z91.5) Personal History of Self-Harm
V62.22 (Z91.82) Personal History of Military Deployment
V15.89 (Z91.89) Other Personal Risk Factors
V69.9 (Z72.9) Problem Related to Lifestyle
This category should be used when a lifestyle problem is a specific focus of treatment or directly
affects the course, prognosis, or treatment of a mental or other medical disorder. Examples
of lifestyle problems include lack of physical exercise, inappropriate diet, high-risk
sexual behavior, and poor sleep hygiene. A problem that is attributable to a symptom of a
mental disorder should not be coded unless that problem is a specific focus of treatment or
directly affects the course, prognosis, or treatment of the individual. In such cases, both the
mental disorder and the lifestyle problem should be coded.
V71.01 (Z72.811) Adult Antisocial Behavior
This category can be used when the focus of clinical attention is adult antisocial behavior
that is not due to a mental disorder (e.g., conduct disorder, antisocial personality disorder).
Examples include the behavior of some professional thieves, racketeers, or dealers in
illegal substances.
V71.02 (Z72.810) Child or Adolescent Antisocial Behavior
This category can be used when the focus of clinical attention is antisocial behavior in a
child or adolescent that is not due to a mental disorder (e.g., intermittent explosive disorder,
conduct disorder). Examples include isolated antisocial acts by children or adolescents
(not a pattern of antisocial behavior).
Problems Related to Access to Medical
and Other Health Care
V63.9 (Z75.3) Unavailability or Inaccessibility of Health Care Facilities
V63.8 (Z75.4) Unavailability or Inaccessibility of Other Helping Agencies
Nonadherence to Medical Treatment
V15.81 (Z91.19) Nonadherence to Medical Treatment
This category can be used when the focus of clinical attention is nonadherence to an important
aspect of treatment for a mental disorder or another medical condition. Reasons
for such nonadherence may include discomfort resulting from treatment (e.g., medication
side effects), expense of treatment, personal value judgments or religious or cultural beliefs
about the proposed treatment, age-related debility, and the presence of a mental disorder
(e.g., schizophrenia, personality disorder). This category should be used only when
the problem is sufficiently severe to warrant independent clinical attention and does not
meet diagnostic criteria for psychological factors affecting other medical conditions.
278.00 (E66.9) Overweight or Obesity
This category may be used when overweight or obesity is a focus of clinical attention.
V65.2 (Z76.5) Malingering
The essential feature of malingering is the intentional production of false or grossly exaggerated
physical or psychological symptoms, motivated by external incentives such as
avoiding military duty, avoiding work, obtaining financial compensation, evading criminal
prosecution, or obtaining drugs. Under some circumstances, malingering may represent adaptive behavior—for example, feigning illness while a captive of the enemy during
wartime. Malingering should be strongly suspected if any combination of the following is
noted:
1. Medicolegal context of presentation (e.g., the individual is referred by an attorney to
the clinician for examination, or the individual self-refers while litigation or criminal
charges are pending).
2. Marked discrepancy between the individual’s claimed stress or disability and the objective
findings and observations.
3. Lack of cooperation during the diagnostic evaluation and in complying with the prescribed
treatment regimen.
4. The presence of antisocial personality disorder.
Malingering differs from factitious disorder in that the motivation for the symptom
production in malingering is an external incentive, whereas in factitious disorder external
incentives are absent. Malingering is differentiated from conversion disorder and somatic
symptom–related mental disorders by the intentional production of symptoms and by the
obvious external incentives associated with it. Definite evidence of feigning (such as clear
evidence that loss of function is present during the examination but not at home) would
suggest a diagnosis of factitious disorder if the individual’s apparent aim is to assume the
sick role, or malingering if it is to obtain an incentive, such as money.
V40.31 (Z91.83) Wandering Associated With a Mental Disorder
This category is used for individuals with a mental disorder whose desire to walk about
leads to significant clinical management or safety concerns. For example, individuals with
major neurocognitive or neurodevelopmental disorders may experience a restless urge to
wander that places them at risk for falls and causes them to leave supervised settings without
needed accompaniment. This category excludes individuals whose intent is to escape
an unwanted housing situation (e.g., children who are running away from home, patients
who no longer wish to remain in the hospital) or those who walk or pace as a result of medication-
induced akathisia.
Coding note: First code associated mental disorder (e.g., major neurocognitive disorder,
autism spectrum disorder), then code V40.31 (Z91.83) wandering associated with
[specific mental disorder].
V62.89 (R41.83) Borderline Intellectual Functioning
This category can be used when an individual’s borderline intellectual functioning is the focus
of clinical attention or has an impact on the individual’s treatment or prognosis. Differentiating
borderline intellectual functioning and mild intellectual disability (intellectual
developmental disorder) requires careful assessment of intellectual and adaptive functions
and their discrepancies, particularly in the presence of co-occurring mental disorders that
may affect patient compliance with standardized testing procedures (e.g., schizophrenia or
attention-deficit/hyperactivity disorder with severe impulsivity).
