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ICD-10 Guide
ICD-10 CodesF45.4

F45.4

Billable

Pain disorders related to psychological factors

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

Code Description

ICD-10 F45.4 is a billable code used to indicate a diagnosis of pain disorders related to psychological factors.

Key Diagnostic Point:

F45.4 refers to pain disorders that are primarily influenced by psychological factors rather than purely physiological causes. This condition often manifests in patients who experience chronic pain that is exacerbated by emotional distress, anxiety, or other psychological issues. Commonly associated psychological disorders include anxiety disorders, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and various phobias. Patients may present with symptoms such as heightened sensitivity to pain, difficulty in coping with pain, and a significant impact on their daily functioning and quality of life. Effective management of F45.4 often requires a multidisciplinary approach, including psychological therapy, medication for anxiety or depression, and pain management strategies. Understanding the interplay between psychological factors and pain perception is crucial for accurate diagnosis and treatment, as well as for appropriate coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between psychological and physiological causes of pain
  • Need for comprehensive documentation of psychological assessments
  • Potential overlap with other mental health diagnoses
  • Variability in patient presentations and responses to treatment

Audit Risk Factors

  • Inadequate documentation of psychological assessments
  • Failure to link pain symptoms to psychological factors
  • Misclassification of pain as purely physical
  • Lack of evidence for treatment modalities used

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Thorough documentation of psychological evaluations, treatment plans, and patient progress notes.

Common Clinical Scenarios

Patients presenting with chronic pain alongside anxiety or mood disorders.

Billing Considerations

Consideration of comorbid mental health conditions and their impact on pain perception.

Pain Management

Documentation Requirements

Detailed records of pain assessments, treatment interventions, and patient responses.

Common Clinical Scenarios

Patients undergoing pain management therapies who also exhibit psychological distress.

Billing Considerations

Integration of psychological evaluations into pain management strategies.

Coding Guidelines

Inclusion Criteria

Use F45.4 When
  • According to ICD
  • 10 guidelines, F45
  • 4 should be used when pain is significantly influenced by psychological factors
  • Documentation must clearly establish the connection between psychological conditions and pain symptoms

Exclusion Criteria

Do NOT use F45.4 When
  • Exclusion criteria include pain disorders that are primarily due to physical causes

Related ICD-10 Codes

Related CPT Codes

90834CPT Code

Psychotherapy, 45 minutes with patient

Clinical Scenario

Used for patients with chronic pain and psychological factors.

Documentation Requirements

Document the therapeutic approach and patient progress.

Specialty Considerations

Psychiatrists should focus on the psychological aspects of pain management.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of pain disorders related to psychological factors, improving the ability to capture the complexity of these conditions and their treatment needs.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pain disorders related to psychological factors, improving the ability to capture the complexity of these conditions and their treatment needs.

Reimbursement & Billing Impact

impact of psychological factors on pain. Providers should ensure that all relevant information is included to support the diagnosis and treatment.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the primary focus of F45.4?

F45.4 focuses on pain disorders where psychological factors significantly influence the perception and experience of pain, requiring a multidisciplinary approach for effective management.