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ICD-10 Guide
ICD-10 CodesF43.12

F43.12

Billable

Post-traumatic stress disorder, chronic

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

Code Description

ICD-10 F43.12 is a billable code used to indicate a diagnosis of post-traumatic stress disorder, chronic.

Key Diagnostic Point:

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after an individual has experienced or witnessed a traumatic event. Chronic PTSD is characterized by symptoms that persist for more than three months and can significantly impair daily functioning. Symptoms include intrusive memories, flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event. Individuals may also experience avoidance behaviors, emotional numbness, and hyperarousal, which can manifest as irritability, difficulty sleeping, and heightened startle responses. The chronic nature of this disorder often leads to co-occurring conditions such as depression and anxiety disorders, complicating treatment and management. Effective management may involve psychotherapy, medication, and support groups, focusing on coping strategies and anxiety management techniques. Understanding the chronicity of PTSD is crucial for healthcare providers to tailor interventions that address both the psychological and physiological aspects of the disorder.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between acute and chronic PTSD
  • Co-occurring mental health conditions
  • Variability in symptom presentation
  • Need for comprehensive documentation of trauma history

Audit Risk Factors

  • Inadequate documentation of trauma history
  • Failure to specify chronicity of symptoms
  • Misclassification of PTSD severity
  • Lack of evidence for co-occurring conditions

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed patient history, symptom severity, treatment plans, and response to therapy.

Common Clinical Scenarios

Patients presenting with chronic PTSD symptoms following military service, sexual assault, or natural disasters.

Billing Considerations

Consideration of comorbid conditions such as depression or substance use disorders is essential for accurate coding.

Psychology

Documentation Requirements

Comprehensive psychological evaluations, treatment progress notes, and patient self-reports.

Common Clinical Scenarios

Therapy sessions focusing on cognitive-behavioral techniques for managing PTSD symptoms.

Billing Considerations

Documentation should reflect the therapeutic approach and patient engagement in treatment.

Coding Guidelines

Inclusion Criteria

Use F43.12 When
  • According to ICD
  • 10 guidelines, PTSD is classified under anxiety disorders
  • Chronic PTSD must be documented with specific symptoms and duration

Exclusion Criteria

Do NOT use F43.12 When
  • Exclusion criteria include conditions that may mimic PTSD symptoms but are not classified as such

Related ICD-10 Codes

Related CPT Codes

90834CPT Code

Psychotherapy, 45 minutes with patient.

Clinical Scenario

Used for ongoing therapy sessions for chronic PTSD management.

Documentation Requirements

Session notes must detail the therapeutic approach and patient progress.

Specialty Considerations

Psychiatrists and psychologists should document the specific techniques used in therapy.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of PTSD, enabling better tracking of the condition and its treatment outcomes. The granularity of ICD-10 codes helps in understanding the chronic nature of PTSD and its impact on healthcare resources.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of PTSD, enabling better tracking of the condition and its treatment outcomes. The granularity of ICD-10 codes helps in understanding the chronic nature of PTSD and its impact on healthcare resources.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of PTSD, enabling better tracking of the condition and its treatment outcomes. The granularity of ICD-10 codes helps in understanding the chronic nature of PTSD and its impact on healthcare resources.

Resources

Clinical References

  • •
    National Center for PTSD

Coding & Billing References

  • •
    National Center for PTSD

Frequently Asked Questions

What distinguishes chronic PTSD from acute PTSD?

Chronic PTSD is characterized by symptoms lasting more than three months, while acute PTSD symptoms occur within three months of the traumatic event.