2025 ICD-10-CM code F45.42
Pain disorder with related psychological factors. This code is used for conditions where pain is the primary focus and is significantly affected by psychological factors.
Medical necessity for services related to F45.42 must be supported by documentation that the pain is significantly impacted by psychological factors and is affecting the patient's function and quality of life.The treatment plan should address both the physical and psychological aspects of the pain, aiming to improve the patient's overall well-being.
Healthcare providers diagnosing F45.42 should consider a biopsychosocial approach, addressing both physical pain management and psychological support. This often involves collaboration between various specialties including primary care, pain management, psychiatry, and psychology.
- Mental, Behavioral and Neurodevelopmental disorders (F01-F99)
- F45.4: Pain disorders related to psychological factorsF45: Somatoform disordersF40-F48: Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disordersF01-F99: Mental, Behavioral and Neurodevelopmental disorders
In simple words: This diagnosis means you have real physical pain, but emotions like stress, worry, or sadness are making it worse or last longer.The doctor will also use another code to explain what kind of pain you have and where it is located.
Pain disorder with related psychological factors refers to a condition where the individual experiences real physical pain, but the intensity, duration, or worsening of the pain is heavily influenced by psychological factors such as stress, anxiety, or depression. This diagnosis is distinct from conditions where pain is solely caused by psychological factors (F45.41).It requires an associated acute or chronic pain code (G89.-) to further specify the location and nature of the pain.
Example 1: A patient with a history of anxiety presents with chronic lower back pain. While an MRI reveals mild degenerative disc disease, the severity of the pain reported is disproportionate to the imaging findings, and the pain is exacerbated during periods of increased stress. F45.42 and G89.1 (Pain in thoracic spine) are appropriate diagnoses., A patient experiences persistent headaches that worsen during stressful work deadlines.Neurological examination and imaging are normal.F45.42 and G44.0 (Tension-type headache) are reported., A patient with depression reports widespread muscle pain and fatigue.Physical examination reveals no specific source of the pain, and it's determined that the patient's depression is significantly contributing to the experience of pain. F45.42 and M79.1 (Myalgia, unspecified) are assigned.
Documentation should clearly demonstrate the relationship between psychological factors and the reported pain. This can include detailed descriptions of the pain, including location, severity, duration, and any exacerbating or alleviating factors.Documentation of the patient's psychological state, including symptoms of stress, anxiety, or depression, is essential. It is crucial also to document the results of any physical examinations, imaging studies, or other diagnostic tests performed to evaluate the pain and rule out other medical causes.
** Pain disorder with related psychological factors is a complex diagnosis requiring a comprehensive evaluation and individualized treatment plan.
- Payment Status: Active