Coding direction: Homelessness

March 18, 2025 — This bulletin clarifies the use of the Canadian definition of homelessness from the Canadian Observatory on Homelessness (COH) for the classification of patients experiencing homelessness to ensure consistent and accurate data collection.

Coding direction

It is mandatory to assign Z59.0 Homelessness as a diagnosis type (3)/other problem.

To assign the code Z59.0 Homelessness, use

• Documentation of homelessness; or 
• Documentation that reflects the components of the COH definition of homelessness, as outlined below.

Do not assign Z59.0 Homelessness for

• History of homelessness; or
• Patients at risk of homelessness. 

Note

Documentation of homelessness is not limited to physician documentation. The intent is to assign a code for homelessness when it is noted on routine review of the record, not to conduct an exhaustive search of all ancillary documentation for reference to homelessness.

When there is uncertainty as to whether a case qualifies as a patient experiencing homelessness, seek clarification from your jurisdiction or facility.

Canadian definition of homelessness

The 3 components of the COH definition of homelessness that may be used to assign the code Z59.0 Homelessness are as follows:

• Unsheltered: Living in public or private spaces without consent or living in places not intended for permanent human habitation (e.g., public spaces such as sidewalks, parks, forests, vacant buildings [squatting], cars or other vehicles, makeshift shelters, shacks or tents).
• Emergency sheltered: Accessing emergency shelter (e.g., emergency overnight shelters, shelters for those impacted by family violence or emergency shelters for people fleeing natural disaster or destruction of accommodation due to fires, floods, etc.).
• Provisionally accommodated: Staying in temporary accommodations (e.g., motel, rooming house, friend’s/family member’s home, temporary housing for immigrants and refugees during settlement without immediate prospects for securing permanent housing).

The fourth component of the COH definition of homelessness — at risk of homelessness — is not used to assign Z59.0.

Now available: Homelessness — Tip for Coders (PDF)