PTSD F Codes
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As a mental health clinician, understanding the right post-traumatic stress disorder (PTSD) F codes to use is important. Using the correct PTSD ICD-10 codes can help you to avoid unnecessary delays in insurance reimbursement and save you valuable time.
With that in mind, this guide provides an overview of the correct PTSD F codes, including a complete list of post-traumatic stress disorder symptoms and the Veterans Affairs (VA) diagnostic code for PTSD, along with specifiers and differential diagnoses.
Bookmark this article as a reference to use next time you need to access information on PTSD ICD-10 codes.
What are ICD-10 codes and DSM codes?
The International Classification of Diseases, Tenth Revision (ICD-10) is a guide published by the World Health Organization (WHO). Clinicians in the U.S. refer to the ICD-10-CM, a clinical modification of the ICD-10 used for diagnosis codes.
These guides help to facilitate the worldwide use of standard diagnostic language and codes to describe mental health conditions in order to measure and track health information around the world.
To diagnose and classify mental disorders, behavioral health practitioners in the U.S. also rely on the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Health Disorders, fifth edition (DSM-5). Along with descriptions and classifications of disorders, the DSM-5 also contains corresponding ICD-10 codes, so you can search by the billable code as well.
PTSD ICD codes
PTSD falls under the section “F43 Reaction to severe stress, and adjustment disorders” within the ICD-10.
The commonly used PTSD ICD-10 codes are:
- 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)
Post-traumatic stress disorder symptoms
PTSD is described in the ICD-10 as arising from a delayed or protracted response to a stressful event or situation that is exceptionally threatening or catastrophic in nature.
There are predisposing factors that may lower the threshold for developing PTSD or aggravate its course, such as neurotic illness.
According to the ICD-10, the common features of PTSD include:
- 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
The onset of PTSD ranges from a few weeks to a few months from the event, and the course varies. It is expected that most people will recover, however, in some cases, PTSD can follow a chronic course over several years, leading to an enduring personality change.
PTSD is one of the most frequently billed ICD-10 codes and is listed at #7 in SimplePractice’s list of the 20 most-frequently billed ICD-10 codes.
VA diagnostic code for PTSD
The Department of Veterans Affairs (VA) evaluates PTSD under the Electronic Code of Federal Regulations (38 C.F.R), Schedule for Rating Disabilities, sub-section § 4.130.
The diagnostic code (DC) for PTSD used by the VA is 9411.
Please note that while the VA may use standard DSM-5 diagnostic criteria, they also require a clinician administered PTSD Scale Test (CAPS-5), which may be supplemented by a self-report test (called a PCL-M).
The information is used to score symptom severity, ranging from 0 to 80, which can determine VA disability benefits. Visit the VA’s National Center for PTSD for more information.
Using the DSM-5 code for PTSD
In order to diagnose PTSD using the DSM-5, the APA requires that an adult, adolescent, or child over 6 years old meets these main diagnostic criteria:
- Exposure to actual or threatened death, serious injury, or sexual violence
- Presence of intrusive symptoms associated with the traumatic event(s)
- Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred
- Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred
- Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred
- Duration of the disturbance (Criteria B, C, D and E) is more than 1 month
- The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition
Please note this is a summary of the diagnostic criteria. More detail can be found in the DSM-5.
Specifiers for PTSD in the DSM-5
According to the DSM-5, clinicians must also specify whether PTSD presents with:
- Dissociative symptoms: The individual’s symptoms meet the criteria for PTSD and the individual experiences persistent or recurrent symptoms of either:
- Depersonalization
- Derealization
- Delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).
Differential diagnoses for PTSD
Even though patients may meet some of the criterion for PTSD, there may be a more appropriate diagnosis, such as:
- Adjustment disorders
- Other types of post-traumatic stress disorders
- Acute stress disorder
- Anxiety disorders
- Obsessive compulsive disorder
- Major depressive disorders
- Attention-deficit hyperactivity disorder
- Personality disorders
- Psychotic disorders
- Dissociative disorders
- Functional neurological symptom disorder (conversion disorder)
- Traumatic brain injury
How to find ICD-10 PTSD F codes
The full list of PTSD F codes is available in the following digital and book formats:
- ICD-10 Data, a searchable ICD-10 database
- The official ICD-10 under the subheading “F43 Reaction to severe stress, and adjustment disorders” and sub-section code F43.1
- DSM-5 throughout the textbook and online. The hard copy contains a handy alphabetical list and numerical list of ICD-10 codes.
It is worth noting that while 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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