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v1.0.0
ICD-10 Guide
DiagnosesAgoraphobia

Agoraphobia

ICD-10 Coding for Agoraphobia(F40.01, F40.02, F40.00)

PRIMARY SPECIALTYPsychiatry
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Agoraphobia?
Essential facts and insights about Agoraphobia

Key Clinical Considerations:

  • The presence of marked fear or anxiety about two (or more) of the following situations: using public transportation, being in open spaces, being in enclosed places, standing in line or being in a crowd, or being outside of the home alone.
  • The fear or anxiety is out of proportion to the actual danger posed by the situations and is persistent, typically lasting for 6 months or more.
  • The avoidance behavior, distress, or impairment in functioning is clinically significant.
  • No other mental disorder can explain the symptoms, such as social anxiety disorder or specific phobia.
  • Severity can be assessed based on the degree of avoidance and the impact on daily functioning.

Clinical Information

Clinical Criteria & Documentation Requirements

  • Document the specific situations that provoke anxiety and the patient's response to these situations.
  • Use terminology such as 'agoraphobia' and specify if it is with or without panic disorder.
  • Examples include: 'Patient exhibits avoidance of public transportation and crowded places due to anxiety.'
  • Medical necessity must be established through documentation of the impact on daily life and functioning.
  • Quality measures may include documentation of treatment plans and follow-up assessments.

Coding Guidelines

Usage Guidelines & Examples

  • Use F40.01 for agoraphobia with panic disorder when panic attacks are present; use F40.00 for agoraphobia without panic disorder.
  • Do not use these codes for patients whose symptoms are better explained by another mental disorder.
  • F40.1 (agoraphobia) is related but does not specify the presence of panic disorder, while F41.0 (panic disorder) is a separate diagnosis.
  • Common errors include misclassifying agoraphobia as a specific phobia; ensure the full criteria are met.
  • In complex cases, consider comorbid conditions and document all relevant symptoms to support code selection.

Code Exclusions

Important Exclusions

  • Exclude codes for specific phobias (F40.8) and social anxiety disorder (F40.10) when the primary issue is agoraphobia.
  • Alternative codes for excluded conditions include F40.81 for specific phobia, situational type.
  • Conditions are excluded to ensure accurate representation of the patient's primary diagnosis.
  • Common mistakes include coding agoraphobia when the primary issue is a specific phobia; ensure clarity in documentation.
  • Related but distinct conditions include panic disorder without agoraphobia (F41.0).

Related ICD-10 Codes

Primary Codes
F40.01
Agoraphobia with panic disorder
F40.02
Agoraphobia without panic disorder
F40.00
Agoraphobia, unspecified
Differential Codes
F41.0
F40.01

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Psychiatry

Specialty Applications

  • Applies to individuals experiencing significant anxiety related to being in situations where escape might be difficult.
  • Patient populations include adults and adolescents, with a higher prevalence in females.
  • Clinical settings include outpatient mental health clinics, inpatient psychiatric units, and emergency departments.
  • Specialty-specific applications are relevant in psychiatry and psychology.
  • Treatment contexts include cognitive-behavioral therapy (CBT) and pharmacotherapy.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Template 1

Template: 'Patient diagnosed with agoraphobia based on clinical findings of avoidance behavior and anxiety in public spaces.'

Template 2

Template: 'Clinical presentation consistent with agoraphobia including marked fear of open spaces and crowded areas.'

Template 3

Template: 'Diagnostic criteria for agoraphobia met as evidenced by persistent avoidance and significant distress.'

Template 4

Template: 'Treatment plan initiated for agoraphobia with cognitive-behavioral therapy and medication management.'

Template 5

Template: 'Follow-up care for agoraphobia including monitoring of anxiety levels and response to treatment.'

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

What documentation is required for this diagnosis?

Detailed documentation of symptoms, triggers, and impact on daily life is required.

How does this differ from similar diagnoses?

Agoraphobia is characterized by fear of situations where escape may be difficult, unlike specific phobias which are limited to specific objects or situations.

What are common billing considerations?

Ensure that the diagnosis is clearly documented to support medical necessity for treatment and reimbursement.

What procedures are typically associated?

CPT codes for therapy sessions, such as 90834 for psychotherapy, may be used.

Are there any quality reporting implications?

Quality measures may include tracking treatment outcomes and patient-reported outcomes related to anxiety symptoms.