2025 ICD-10-CM code F54
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Mental, Behavioral and Neurodevelopmental disorders - Behavioral syndromes associated with physiological disturbances and physical factors (F50-F59) Chapter V: Mental, Behavioral and Neurodevelopmental disorders (F01-F99) Feed
Psychological and behavioral factors affecting other medical conditions.Code the physical disorder first.
Not applicable to ICD-10 codes. Modifiers apply to CPT and HCPCS codes.
Medical necessity for F54 is established when the documentation clearly demonstrates a direct causal link between psychological or behavioral factors and a negative impact on the course or management of an established medical condition. The impact must be significant enough to warrant separate coding.Payers may have specific criteria for medical necessity which should be confirmed.
The clinical responsibility lies with the physician or qualified healthcare professional managing both the patient's physical and mental health conditions. This requires a comprehensive assessment to understand the interplay between the physical and psychological factors.Treatment may include medical management of the primary physical condition and psychotherapy or other mental health interventions to address the behavioral factors influencing the physical health.
- Chapter V: Mental, Behavioral and Neurodevelopmental disorders (F01-F99)
- Chapter V: Mental, Behavioral and Neurodevelopmental disorders (F01-F99) > Behavioral syndromes associated with physiological disturbances and physical factors (F50-F59)
In simple words: This code is used when someone's mental health or behavior problems make it harder to manage a physical health problem.The doctor will code the physical problem first, and then this code if the mental health issue makes the physical problem worse.
This code, F54, represents psychological and behavioral factors that influence or complicate other medical conditions.It is crucial to remember that this code is always secondary; the primary diagnosis should be the underlying physical or medical condition.Examples include situations where psychological issues, such as denial or non-compliance, negatively impact the management or treatment of conditions like diabetes, heart disease, or asthma. The diagnosis is determined through a comprehensive assessment including medical history, mental health history, physical examination, and consideration of criteria from resources like the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Example 1: A patient with type 2 diabetes mellitus (E11.9) consistently misses appointments and does not adhere to prescribed medication or diet, leading to poor glycemic control.F54 would be a secondary code to reflect the impact of the patient's non-compliance, which is a behavioral factor., A patient diagnosed with chronic obstructive pulmonary disease (J44.9) experiences significant anxiety (F41.1), leading to increased shortness of breath and exacerbations of their COPD. F54 would be a secondary code documenting the influence of anxiety on the respiratory condition., A patient with hypertension (I10) denies the severity of their condition and refuses to take prescribed medications.This denial, a behavioral factor, negatively impacts their blood pressure management. F54 is coded secondarily to reflect this.
Detailed medical history addressing both the physical and psychological aspects of the patient's condition.Documentation of the physical examination findings and the results of diagnostic testing (e.g., lab work, imaging studies) related to the primary physical condition.Documentation of the assessment of the psychological or behavioral factors, including the use of validated assessment tools or clinical criteria like the DSM.A clear description of how the psychological or behavioral factors negatively influence the physical condition's course or management. Treatment plan addressing both the physical and psychological aspects.
** The information provided should be verified against the latest official ICD-10-CM coding guidelines.Accurate documentation is vital for appropriate coding and reimbursement.
- Revenue Code: Unknown. Revenue codes are dependent on the specific service provided and the payer.
- RVU: Not applicable to ICD-10 codes. RVUs are associated with CPT codes.
- Global Days: Not applicable to ICD-10 codes. Global days are associated with surgical CPT codes.
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD-10 codes. TC modifiers apply to CPT and HCPCS codes.
- Fee Schedule: Not applicable to ICD-10 codes. Fee schedules apply to CPT and HCPCS codes.
- Specialties:Psychiatry, Internal Medicine, Cardiology, Endocrinology, Pulmonology, and other specialties relevant to the underlying physical condition.
- Place of Service:Office, Hospital (Inpatient or Outpatient), Skilled Nursing Facility, and other settings appropriate to the management of both the physical and mental health conditions.