Finding the Right ICD-10 Code for Chronic PTSD
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It’s essential for behavioral health professionals to use the right ICD-10 code for PTSD (post-traumatic stress disorder). There are various degrees of PTSD that are codified in the ICD-10—like the ICD-10 code for chronic PTSD, the complex PTSD ICD-10 code, and the ICD-10 code for acute PTSD.
ICD-10 codes can support a diagnosis, help you create an individualized treatment plan, and ensure that your practice runs smoothly.
Using the correct ICD-10 code for PTSD can also help avoid unnecessary delays in insurance reimbursement and save you valuable time.
This guide provides an overview of the correct ICD-10 code for chronic PTSD, including a complete list of chronic PTSD symptoms and information about the ICD-10 code for PTSD unspecified and PTSD acute.
Bookmark this article as a reference to use next time you need to access information on the ICD-10 code for chronic PTSD and its symptoms.
What is the ICD-10 and the DSM-5?
The International Classification of Diseases, Tenth Revision (ICD-10) is an international guide published by the World Health Organization (WHO), which uses standard diagnostic language and codes to describe physical and mental health conditions. Clinicians in the U.S. refer to the ICD-10-CM, a clinical modification of the ICD-10 used for diagnosis codes.
Recording diagnoses in this way can help public health officials measure and track valuable health information.
Behavioral health practitioners in the U.S. also use the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Health Disorders, fifth edition (DSM-5).
The DSM-5 also contains ICD-10 codes, in addition to more expansive diagnostic criteria, such as PTSD differential diagnoses and comorbidities.
Symptoms of PTSD chronic vs acute
The ICD-10 describes PTSD as a class of traumatic stress disorders—with varying degrees of severity, symptom duration, and distinguishing criteria.
There are various forms of PTSD, including:
- Acute PTSD: symptoms only last one to three months.
- Chronic PTSD: characterized by symptoms lasting for more than three months.
- Delayed onset: when symptoms do not develop until six months after the traumatic event.
PTSD arises as a response to a stressful event or situation—of an exceptionally threatening or catastrophic nature. The ICD-10 goes on to advise that there are predisposing factors that may lower the threshold for developing PTSD, or aggravate its course, such as a neurotic illness.
Here are the ICD-10 PTSD criteria to consider during diagnosis:
- Episodes of reliving the trauma in intrusive memories (flashbacks), dreams, or nightmares, with symptoms described as:
- Numbness
- Emotional blunting
- Detachment from others
- Unresponsiveness to surroundings
- Anhedonia
- Avoiding situations that remind them of the traumatic event
- Autonomic hyperarousal with hypervigilance
- Enhanced reactivity or feeling “startled”
- Anxiety and depression
- Suicidal ideation
While it is expected that most people will recover from PTSD, some may develop the condition chronically and experience an enduring personality change.
ICD-10 codes for PTSD
ICD-10 codes for PTSD are classified in the section “F43 Reaction to severe stress, and adjustment disorders.”
The specific ICD-10 codes related to PTSD are as follows:
- Post-traumatic stress disorder (code F43.1)
- Note: This code should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail.
- Post-traumatic stress disorder, unspecified (code F43.10)
- Post-traumatic stress disorder, acute (code F43.11)
- Post-traumatic stress disorder, chronic (code F43.12)
The ICD-10 code for chronic PTSD is one of the most frequently billed ICD-10 codes, ranking at number eight in SimplePractice’s list of the 20 most-frequently billed ICD-10 codes.
For more information on the diagnostic criteria and specifiers for PTSD, read the article on PTSD F codes.
What is the complex PTSD ICD-10 code?
Complex PTSD is defined as chronic trauma that is repeated or prolonged for months or years.
It is also commonly associated with:
- Behavioral difficulties such as impulsivity, aggressiveness, or alcohol/drug misuse
- Emotional difficulties like rage, depression, and panic
- Cognitive difficulties, such as dissociation or changes in personal identity
- Interpersonal difficulties such as chaotic personal relationships
- Somatization (which results in many visits to medical practitioners)
The ICD-10 and the DSM-5 do not contain a code for complex post-traumatic stress disorder (C-PTSD or CPTSD).
According to the results from the U.S. Department of Veterans Affairs field trials, 92% of C-PTSD patients also met the criteria for PTSD, which is why the DSM-5 excluded complex PTSD as a separate diagnosis.
The ICD-10 also left out any mention of CPTSD, but it appears in the latest revision, the ICD-11.
The ICD-11 identifies two distinct related conditions in the category “Disorders specifically associated with stress,” which are:
- PTSD (code 6B40)
- CPTSD (code 6B41)
Differential diagnoses for chronic PTSD
Even though patients may meet some of the criterion for chronic PTSD, there may be a more appropriate diagnosis, such as:
- Adjustment disorders
- Other posttraumatic stress disorders and conditions
- Acute stress disorder
- Personality disorders
- Psychotic disorders
- Dissociative disorders
- Functional neurological symptom disorder (conversion disorder)
- Anxiety disorders
- Obsessive compulsive disorder
- Major depressive disorders
- Attention-deficit hyperactivity disorder
- Traumatic brain injury
How to find the ICD-10 code for chronic PTSD
The full list of ICD-10 codes for chronic PTSD is available in the following digital and book formats:
- ICD-10 Data, a searchable ICD-10 database.
- The official ICD-10 from the WHO under the subheading F43 “Reaction to severe stress, and adjustment disorders” and sub-section F43.1, “Post-traumatic stress disorder.”
- The DSM-5 throughout the textbook and online. The hard copy contains a handy alphabetical list and numerical list of ICD-10 codes.
Please note that even though the DSM-5 does contain accurate ICD-10 codes, they may not align with the most recent ICD version and diagnostic criteria and other indicators may differ.
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