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ICD-10 Guide
ICD-10 CodesChapter 5: Mental, Behavioral and Neurodevelopmental disordersF42

F42

Billable

Obsessive-compulsive disorder

Chapter 5:Mental, Behavioral and Neurodevelopmental disorders

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 F42 is a billable code used to indicate a diagnosis of obsessive-compulsive disorder.

Key Diagnostic Point:

Obsessive-compulsive disorder (OCD) is a chronic mental health condition characterized by persistent, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that the individual feels driven to perform. These obsessions and compulsions can significantly interfere with daily functioning and quality of life. Common obsessions include fears of contamination, fears of harming oneself or others, and fears of making a mistake. Compulsions may involve excessive cleaning, checking, counting, or repeating actions. The disorder can manifest in various forms and severity, often leading to significant anxiety and distress. Diagnosis is typically made based on clinical evaluation, including a thorough history and assessment of symptoms. Treatment options include cognitive-behavioral therapy (CBT), particularly exposure and response prevention (ERP), and pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs). Early intervention and a comprehensive treatment plan are crucial for managing symptoms effectively.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in symptom presentation and severity
  • Need for comprehensive documentation of both obsessions and compulsions
  • Potential overlap with other anxiety disorders
  • Requirement for ongoing treatment documentation

Audit Risk Factors

  • Inadequate documentation of symptoms and treatment
  • Failure to differentiate OCD from other anxiety disorders
  • Lack of evidence for the necessity of treatment
  • Inconsistent coding of co-occurring conditions

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed patient history, symptom severity, treatment response, and any co-occurring disorders.

Common Clinical Scenarios

Initial diagnosis of OCD, treatment planning, and ongoing management of symptoms.

Billing Considerations

Documentation must clearly outline the nature of obsessions and compulsions, as well as the impact on daily functioning.

Psychology

Documentation Requirements

Comprehensive psychological assessments, including standardized measures of OCD symptoms.

Common Clinical Scenarios

Cognitive-behavioral therapy sessions focusing on exposure and response prevention.

Billing Considerations

Therapist notes should reflect the therapeutic process and patient progress in managing OCD symptoms.

Coding Guidelines

Inclusion Criteria

Use F42 When
  • According to ICD
  • 10 coding guidelines, F42 should be used when the patient meets the criteria for obsessive
  • compulsive disorder as defined in the DSM
  • Documentation must support the diagnosis, including the presence of obsessions and compulsions, their impact on functioning, and any treatment provided

Exclusion Criteria

Do NOT use F42 When
No specific exclusions found.

Related CPT Codes

90834CPT Code

Psychotherapy, 45 minutes with patient

Clinical Scenario

Used for therapy sessions focused on managing OCD symptoms.

Documentation Requirements

Session notes must detail the therapeutic approach and patient progress.

Specialty Considerations

Psychiatrists and psychologists should ensure that the therapy aligns with the treatment plan for OCD.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of OCD, improving the ability to track and manage the disorder. It has also emphasized the need for detailed documentation to support the diagnosis and treatment.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of OCD, improving the ability to track and manage the disorder. It has also emphasized the need for detailed documentation to support the diagnosis and treatment.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of OCD, improving the ability to track and manage the disorder. It has also emphasized the need for detailed documentation to support the diagnosis and treatment.

Resources

Clinical References

  • •
    American Psychiatric Association - OCD

Coding & Billing References

  • •
    American Psychiatric Association - OCD

Frequently Asked Questions

What is the difference between OCD and obsessive-compulsive personality disorder?

OCD is characterized by unwanted obsessions and compulsions that cause significant distress, while obsessive-compulsive personality disorder involves a pervasive pattern of perfectionism and control without the presence of true obsessions or compulsions.