What Is the F43 Diagnosis Code?
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Determining the right F43 diagnosis code to use for reaction to severe stress and adjustment disorders is essential for billing and insurance reimbursement.
This comprehensive guide to the F43 diagnosis code provides a helpful overview of the code for reaction to severe stress and adjustment disorder, along with diagnostic criteria and specifiers for mental health clinicians.
Using the appropriate ICD-10 codes is critical for clinicians during the assessment process and when communicating with insurance payers.
Bookmark this article as a reference to use next time you need to access F43 symptoms and diagnostic coding information.
What are F codes?
F codes are used by clinicians globally to describe health conditions in a widely used diagnosis guide called the International Classification of Diseases (ICD-10), published by the World Health Organization (WHO).
F codes are ICD-10 codes—which start with the letter “F”—and fall under the “Mental, behavioral and neurodevelopmental disorders” (F01-F99) category in the ICD-10.
The ICD-10 uses standard diagnostic language to report health conditions and standardize diagnostic information. In the United States, clinicians refer to the ICD-10-CM, a clinical modification of the ICD-10 used for diagnosis codes.
In addition, clinicians use a similar guide, called the Diagnostic and Statistical Manual of Mental Health Disorders, fifth edition (DSM-5), published by the American Psychiatric Association (APA). The current version of the DSM-5 also contains F43 diagnosis code information.
What is the ICD-10 code for reaction to severe stress?
ICD-10 codes are used to record a diagnosis following a mental health evaluation, insurance billing purposes, and to standardize the recording of mental health diagnoses.
You can find the F43 diagnosis code in the ICD-10 under the section “Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders” (F40-F48), and the sub-section “Reaction to severe stress, and adjustment disorders” (F43-F43.9).
There are several diagnosis codes listed in the reaction to severe stress, and adjustment disorder section, which includes the ICD-10 code for reaction to severe stress.
The following stress and adjustment-related disorders fall under the F43 diagnosis code heading:
- F43.0: Acute stress reaction
- F43.1: Post-traumatic stress disorder (PTSD)
- Note: This code should not be used for reimbursement purposes. Instead, use one of the codes below it that contains a greater level of detail.
- F43.10: Post-traumatic stress disorder, unspecified
- F43.11: Post-traumatic stress disorder, acute
- F43.12: Post-traumatic stress disorder, chronic
- F43.2: Adjustment disorders
- Note: This code should not be used for reimbursement purposes. Instead, use one of the codes below it that contains a greater level of detail.
- F43.20: Adjustment disorder, unspecified
- F43.21: Adjustment disorder with depressed mood
- F43.22: Adjustment disorder with anxiety
- F43.23: Adjustment disorder with mixed anxiety and depressed mood
- F43.24: Adjustment disorder with disturbance of conduct
- F43.25: Adjustment disorder with mixed disturbance of emotions and conduct
- F43.29: Adjustment disorder with other symptoms
- F43.8: Other reactions to severe stress
- Note: This code should not be used for reimbursement purposes. Instead, use one of the codes below it that contains a greater level of detail.
- F43.81: Prolonged grief disorder
- F43.89: Other reactions to severe stress
- F43.9: Reaction to severe stress, unspecified
Several F43 diagnosis codes appear in SimplePractice’s article of the 20 most-frequently billed ICD-10 codes:
- #2: F43.23, Adjustment disorder with mixed anxiety and depressive mood
- #4: F43.22, Adjustment disorder with anxiety
- #6: F43.20, Adjustment disorder, unspecified
- #7: F43.10, Post traumatic stress disorder, unspecified
- #8: F43.12, Post traumatic stress disorder, chronic
- #10: F43.21, Adjustment disorder with depressed mood
F43 criteria for diagnosis
The ICD-10 specifies that the F43 diagnosis code is identifiable on the symptoms and the existence of one or two causes/influences:
- An exceptionally traumatic life event resulting in an acute stress reaction
- A significant life change leading to continued unpleasant circumstances that result in an adjustment disorder
The definition goes on to describe that this section brings together disorders “as a direct consequence of acute severe stress or continued trauma.”
The stressful event or unpleasant circumstances are the primary or overriding cause, and the disorder would not have occurred without them. These disorders are considered “maladaptive responses to severe or continued stress,” which impact coping mechanisms and social functioning.
DSM-5 stress and adjustment disorder diagnostic criteria
While the F43 diagnosis codes are the same as in the ICD-10, the DSM-5 includes more detailed diagnostic criteria.
The specific criteria for the F43.0 diagnosis code, acute stress disorder, are as follows:
A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:
- Directly experiencing the traumatic event(s)
- Witnessing, in person, the event(s) as it occurred to others
- Learning that the event(s) occurred to a close family member or close friend
- Experiencing repeated or extreme exposure to aversive details of the traumatic event(s)
B. Presence of nine or more of the following symptoms from any of the five categories, beginning or worsening after the traumatic event(s) occurred:
- Intrusion Symptoms
- Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s)
- Recurrent distressing dreams in which the content and/or effect of the dream are related to the event(s)
- Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring
- Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
- Negative Mood
- Persistent inability to experience positive emotions
- Dissociative Symptoms
- An altered sense of the reality of one’s surroundings or oneself
- Inability to remember an important aspect of the traumatic event(s)
- Avoidance Symptoms
- Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)
- Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)
- Arousal Symptoms
- Sleep disturbance
- Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects
- Hypervigilance
- Problems with concentration
- Exaggerated startle response
C. Duration of the symptoms is anywhere from three days to one month after trauma exposure.
D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by brief psychotic disorder.
Note: This is a summarized list of key information. For a more extensive description, see the acute stress disorder section in the DSM-5.
Differential diagnosis for stress and adjustment disorders
While some patients may meet one or two of the criteria for a stress and adjustment disorder, there may be a more appropriate diagnosis to consider, such as:
- Panic disorder
- Post-traumatic stress disorder
- Dissociative disorders
- Obsessive-compulsive disorder
- Psychotic disorders
- Traumatic brain injury
How to find the correct F codes
The full list of codes for reaction to severe stress can be found in digital and book formats:
- The official ICD-10 from the WHO under the section “Reaction to severe stress, and adjustment disorders” (F43 to F43.9)
- ICD-10 Data, a searchable ICD-10 database
- DSM-5 in the textbook and digital version
It is worth noting that while the DSM-5 does contain accurate ICD-10 codes, they may not align with the most recent ICD-10 version, and diagnostic criteria and other indicators may differ.
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