ICD 10 Codes Mental Health Therapy Billing
Post-traumatic stress disorder (PTSD) ICD-10 is an International Classification Disease code used to describe a PTSD diagnosis when billing insurance. While F43.1 is a PTSD designation, more specific codes would be needed for billing purposes. Clients must meet specific criteria including exposure to a catastrophic stressor, reliving the stressor and prolonged avoidance of the stressor, among other symptoms to be classified under PTSD ICD-10. Other conditions such as acute stress reaction and adjustment disorder can sometimes be confused with PTSD posing certain concerns in the PTSD ICD-10 diagnosis.
Post-traumatic stress disorder (PTSD) is a condition caused by experiences that go beyond everyday stressors. Trauma, such as rape, serious accidents, and death, shatter our feelings of security and strain our coping abilities. Post-traumatic stress disorder (PTSD) is a condition that often arises from such challenges. Let’s take a closer look at PTSD, its criteria in the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10), and some of the difficulties that may emerge from diagnosis.
Post traumatic stress disorder ICD-10 codes
The general PTSD ICD-10 code is F43.1 but in actual practice, you would use one of the following three specifier codes:
- F43.10: Post-traumatic stress disorder, unspecified. This is a case where the criteria are met for PTSD but the onset and duration are somewhat murky and cannot be clearly delineated.
- F43.11: Post-traumatic stress disorder, acute. In the acute form, the duration of the symptoms is between 1 to 3 months. Symptoms must be present for at least a few weeks to be diagnosed as PTSD.
- F43.12: Post-traumatic stress disorder, chronic. In the chronic form, symptoms last more than 3 months.
Post-traumatic stress disorder, Unspecified
Post-traumatic stress disorder, Acute
Post-traumatic stress disorder, Chronic
What is post-traumatic stress disorder ICD 10 and its criteria
1. The first criterion of PTSD is that the individual must be exposed to an event of a “threatening or catastrophic nature”. This is a stressor above and beyond those you would find in everyday life. A classic example is encountering a combat situation in a war zone.
2. There must be persistent remembering or 'reliving' of the stressor which includes at least one of the following symptoms:
- Distressing recollections, including images, thoughts, or perceptions of the event
- Distressing dreams related to the trauma
- Dissociative flashbacks where the individual feels the traumatic event is recurring
- Physiological reactivity when exposed to internal or external reminders of the event
- Intense psychological distress when exposed to internal or external reminders of the event.
3. The individual must exhibit an actual or preferred avoidance of situations associated with the stressor. These include at least one of the following symptoms:
- Avoiding internal reminders, such as thoughts and feelings associated with the event.
- Avoiding external reminders, such as activities, places, and people associated with the event.
4. Either of the following must be present:
a. Specific amnesia, the inability to recall a significant aspect of the traumatic event.
b. Symptoms of increased psychological sensitivity and arousal exhibited by any two of the following symptoms (not present prior to the event):
- Difficulty in falling or staying asleep
- Irritability or outbursts of anger
- Difficulty in concentrating
- Exaggerated startle response
5. Criteria 2, 3, and 4 must all be met within six months of the traumatic event or at the end of a period of stress. Onset delayed more than six months may be included (the DSM-5 has a delayed onset specification) but should be clearly marked.
Differential diagnosis of PTSD
PTSD is not the only disorder that can arise as a result of stress. Two other disorders, in particular, are often confused diagnostically with PTSD.
F43.0 Acute stress reaction
Acute stress reaction has an identifiable stressor and may have similar symptoms to PTSD (e.g., recollections of the stressor; avoidance of stimuli that reminds one of the stressful event) However, the condition, by definition, can last no more than a month. If it does, it likely should be diagnosed as PTSD.
F43.2 Adjustment disorders
Like PTSD, adjustment disorders have an identifiable stressor and share some of the same features as PTSD. And similar to PTSD, symptoms can be acute or chronic.
Adjustment Disorders are specified by their symptom cluster, which involves depression, anxiety, and behavioral problems (or a mix of those features).
The main differences between adjustment disorders and PTSD are that the symptoms are not as severe and they tend to focus more on emotions. They also don’t concentrate on the components of avoidance, recollection, and arousal. Those three features—and their duration—set PTSD apart from other disorders.
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Concerns for the PTSD ICD-10 diagnosis
The following are diagnostic questions when diagnosing PTSD:
What is meant by exposure to a traumatic event?
Contrary to common belief, you can be exposed to a traumatic event without being directly victimized by it. This can occur by seeing it happen to someone else or even hearing that it happened to someone you care about. For example, a first responder who sees a victim after they have been in a car accident may develop PTSD. Or, someone finding out that a relative has been the victim of forcible rape may feel traumatized simply because they heard it happened.
Does PTSD only occur after a terrifying event?
PTSD is officially recognized in the ICD-10 as a reaction to a very severe negative event, such as extreme violence. But some psychologists maintain that you can develop PTSD with a less severe stressor. While technically you are not supposed to diagnose PTSD ICD-10 without an almost catastrophic incident, some professionals are stating the case for that criteria to be changed. Whether or not you would be willing to diagnose PTSD in someone who has been exposed to a lesser stressor may be considered a case of professional discretion.
PTSD diagnosis will narrow in the near future
The PTSD ICD-10 has possible 13 symptoms used to diagnose this condition. This will soon change in the ICD-11, to six symptoms. Specific criteria, including sleep and concentration problems, will be removed. What this means is that a PTSD diagnosis will be harder to achieve when the ICD-11 becomes viable in the United States.
On the surface, the PTSD ICD-10 diagnosis would seem straightforward. However, other stress-related disorders may be easily confused with PTSD. Further, the criteria for PTSD are dynamic and may be interpreted in several ways. All of this makes the diagnosis of PTSD more difficult. As a practitioner, you want to simplify the process of accurate diagnosis.
Prevalence of post traumatic stress disorder
An estimated 3.6% of American adults had PTSD in the past year and 6.8% will develop it over their lifetimes. The prevalence rate was higher for females (5.2%) than for males (1.8%). In adolescents, the lifetime prevalence is five%.
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