2025 ICD-10-CM code F43.20
(Active) Effective Date: N/A Revision Date: N/A Mental and Behavioral Disorders - Adjustment disorders Chapter V: Mental and behavioural disorders Feed
Unspecified adjustment disorder is a mental health condition where a person's emotional or behavioral response to a stressful event is disproportionate to the event itself, causing significant impairment in daily life.
Modifiers may apply depending on the circumstances of service delivery. Consult the latest CMS guidelines for applicable modifiers.
Medical necessity is established when the patient demonstrates clinically significant distress or impairment in social, occupational, or other important areas of functioning directly attributable to an identifiable stressor, and the symptoms are disproportionate to the stressor.The diagnosis must be supported by clinical findings and documentation.
The clinical responsibility involves assessing the patient's symptoms, identifying the stressors, evaluating the impact on their functioning, and developing a treatment plan. This might include psychotherapy, medication management (antidepressants or anxiolytics), or other interventions to improve coping skills and reduce symptoms.
- Chapter V: Mental and behavioural disorders
- F43.20 falls under the broader category of F43: Reaction to severe stress, and adjustment disorders.
In simple words: This code means someone is having trouble coping with a stressful event like a job loss, divorce, or illness.Their reaction is much bigger than what you'd expect, making it hard for them to function normally at work or home.It usually goes away once the stressful situation ends or they learn to cope better.
F43.20, Adjustment disorder, unspecified, is an ICD-10-CM code classifying a mental disorder characterized by emotional or behavioral symptoms developing within three months of an identifiable stressor.These symptoms are out of proportion to the severity or intensity of the stressor, considering external context and cultural factors, and significantly impair social or occupational functioning.The symptoms do not persist for more than six months after the stressor or its consequences cease.This code is used when the specific type of adjustment disorder (e.g., with depressed mood, anxiety, or conduct disturbance) is not documented.
Example 1: A 35-year-old woman experiences intense anxiety and difficulty sleeping after unexpectedly losing her job. Her anxiety is significantly impacting her daily life and relationships., A 16-year-old boy engages in disruptive behavior at school and home following the death of a close family member. His response is more severe than typically seen in grief., A 60-year-old man exhibits significant depressive symptoms and social withdrawal following a serious health diagnosis, impacting his ability to maintain social connections and manage daily tasks.
Documentation should include a detailed description of the stressful event(s), onset of symptoms, symptom severity, impact on functioning (social, occupational), and the duration of symptoms.Mental status examination findings, relevant past medical and psychiatric history, and treatment plan should also be documented.
** Differential diagnosis should consider other mental health disorders that may share similar symptoms.The temporal relationship between the stressor and symptom onset is crucial for diagnosis.Consider the patient’s cultural background when assessing the proportionality of the response.
- Payment Status: Active
- Specialties:Psychiatry, Psychology, Social Work, Family Medicine, General Practice
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital, Other Place of Service