2025 ICD-10-CM code F43.10
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Mental health disorder - Reaction to severe stress and adjustment disorders Mental, Behavioral, and Neurodevelopmental disorders (F01-F99) Feed
Post-traumatic stress disorder (PTSD), unspecified.
Modifiers may be applicable depending on the circumstances of the service provided. Consult your payer guidelines.
Medical necessity for PTSD diagnosis and treatment is established through a thorough clinical evaluation demonstrating the presence of symptoms consistent with PTSD criteria, impacting the patient's daily functioning and requiring professional intervention.
Diagnosis and treatment of PTSD. This would typically involve a detailed history and mental status exam, as well as possibly psychological testing.The physician or qualified mental health provider is responsible for developing and monitoring a treatment plan, which may include medication management, therapy (such as CBT or trauma-focused therapy), and/or referral to other specialists.
- Mental, Behavioral, and Neurodevelopmental disorders (F01-F99)
- F43 (Reaction to severe stress and adjustment disorders)
In simple words: This code means the person has post-traumatic stress disorder (PTSD) but it's not clear if it's short-term or long-term.PTSD is a serious condition caused by experiencing or seeing something very scary or harmful. It can cause anxiety, nightmares, flashbacks, and trouble sleeping. The person may also avoid things that remind them of the trauma. Doctors use this code to help track and treat the condition.
F43.10 is a billable ICD-10-CM code representing post-traumatic stress disorder (PTSD) where the specification of acute or chronic PTSD is not available or documented.This diagnosis is characterized by anxiety stemming from experiencing or witnessing trauma (e.g., assault, accident, combat). Symptoms can include flashbacks, avoidance behaviors, nervousness, sleep disturbances, nightmares, negative thoughts, anger outbursts, loss of interest, apathy, guilt, shame, hypervigilance, and easily startled responses.The onset can be delayed for months or years after the traumatic event.Diagnosis relies on the DSM-5 criteria, patient history, symptoms, and examination. Treatment options may include antidepressants, anxiolytics, psychotherapy (including CBT), desensitization/exposure therapy, and cognitive restructuring.
Example 1: A veteran presents with flashbacks, nightmares, and avoidance of crowds following their deployment to a combat zone.F43.10 is used because the duration of symptoms is not yet established., A patient reports persistent anxiety, intrusive thoughts, and sleep disturbances after a severe car accident.F43.10 is applied as the provider hasn't determined if the PTSD is acute or chronic., A child experiences nightmares and bedwetting after witnessing domestic violence. F43.10 is utilized because the provider hasn't classified the PTSD as acute or chronic and further assessment is needed.
Detailed history of traumatic event(s), current symptoms (including severity and duration), mental status examination, diagnostic testing (if applicable), treatment plan, and progress notes.
** Accurate documentation is crucial for appropriate coding and reimbursement.If possible, specify the type of PTSD (e.g., acute or chronic) using a more specific code if the information is available.Consider using additional codes to capture other co-occurring mental health conditions.
- Revenue Code: Revenue codes will vary depending on the payer and the services rendered. Consult your payer's guidelines.
- RVU: RVUs are not applicable to ICD codes. RVUs are associated with CPT codes which describe procedures and services.
- Global Days: Not applicable to ICD codes.
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD codes.
- Fee Schedule: Not applicable to ICD codes.
- Specialties:Psychiatry, Psychology, Social Work, Primary Care
- Place of Service:Office, Hospital (Inpatient or Outpatient), Mental Health Facility, Other