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v1.0.0
ICD-10 Guide
ICD-10 CodesR45.85

R45.85

Homicidal and suicidal ideations

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R45.85 is a billable code used to indicate a diagnosis of homicidal and suicidal ideations.

Key Diagnostic Point:

Homicidal and suicidal ideations refer to thoughts or plans regarding self-harm or harm to others. These ideations can manifest as fleeting thoughts or more persistent and detailed plans. Patients may express feelings of hopelessness, worthlessness, or anger, which can escalate to thoughts of suicide or violence. The presence of these ideations often indicates underlying mental health disorders such as depression, anxiety, or personality disorders. Clinical assessment typically involves evaluating the severity, frequency, and context of these thoughts, as well as any associated risk factors such as previous attempts, substance abuse, or significant life stressors. It is crucial for healthcare providers to document the patient's mental state, any expressed intent, and the presence of protective factors to ensure appropriate management and follow-up.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variability in patient presentation and severity of ideations
  • Need for comprehensive mental health assessment
  • Potential for co-occurring mental health disorders
  • Documentation requirements for risk assessment

Audit Risk Factors

  • Inadequate documentation of ideation severity
  • Failure to note risk factors or protective factors
  • Misclassification of ideations as a primary diagnosis
  • Lack of follow-up documentation

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed mental health history, including any prior ideations or attempts, current stressors, and coping mechanisms.

Common Clinical Scenarios

Patients presenting with chronic illness may express suicidal ideations due to the burden of their condition.

Billing Considerations

Internal medicine providers should collaborate with mental health professionals for comprehensive care.

Emergency Medicine

Documentation Requirements

Immediate assessment of risk, including intent, plan, and means to carry out ideations.

Common Clinical Scenarios

Patients presenting after a suicide attempt or with acute suicidal thoughts.

Billing Considerations

Emergency settings require rapid assessment and intervention, with clear documentation of findings and actions taken.

Coding Guidelines

Inclusion Criteria

Use R45.85 When
  • Coders should follow official ICD
  • 10 guidelines, ensuring that R45
  • 85 is used when ideations are present without a definitive diagnosis of a mental disorder
  • Documentation must support the use of this code, including the context and severity of ideations

Exclusion Criteria

Do NOT use R45.85 When
No specific exclusions found.

Related CPT Codes

90791CPT Code

Psychiatric diagnostic evaluation

Clinical Scenario

Used when a patient presents with suicidal ideations for a comprehensive evaluation.

Documentation Requirements

Complete mental health history, risk assessment, and treatment plan.

Specialty Considerations

Psychiatrists should ensure thorough documentation to support the evaluation.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of mental health conditions, including suicidal and homicidal ideations, which were less clearly defined in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of mental health conditions, including suicidal and homicidal ideations, which were less clearly defined in ICD-9.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of mental health conditions, including suicidal and homicidal ideations, which were less clearly defined in ICD-9.

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

When should R45.85 be used?

R45.85 should be used when a patient expresses thoughts or plans of self-harm or harm to others, and these ideations are documented as part of the clinical assessment.