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ICD-10 Guide
ICD-10 CodesR46

R46

Symptoms and signs involving appearance and behavior

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

Code Description

ICD-10 R46 is a used to indicate a diagnosis of symptoms and signs involving appearance and behavior.

Key Diagnostic Point:

The ICD-10 Level 1 Category code R46 encompasses a range of symptoms and signs that pertain to an individual's appearance and behavior. This category is crucial for identifying non-specific symptoms that may indicate underlying psychological or neurological conditions. It includes various presentations such as abnormal gait, altered mental status, and changes in personal hygiene or grooming habits. Clinicians often utilize this code when the specific diagnosis is not yet determined, but the symptoms warrant further investigation or management. It serves as a bridge for healthcare providers to document and communicate the patient's condition effectively while additional diagnostic workup is ongoing.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of symptoms covered
  • Potential overlap with other codes
  • Need for thorough clinical evaluation

Audit Risk Factors

  • Ambiguity in symptom documentation
  • Potential for misclassification
  • Inadequate clinical rationale for coding

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Neurology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related Codes

Child Codes

11 codes
R46.0
Very low level of personal hygiene
R46.1
Bizarre personal appearance
R46.2
Strange and inexplicable behavior
R46.3
Overactivity
R46.4
Slowness and poor responsiveness
R46.5
Suspiciousness and marked evasiveness
R46.6
Undue concern and preoccupation with stressful events
R46.7
Verbosity and circumstantial detail obscuring reason for contact
R46.8
Other symptoms and signs involving appearance and behavior
R46.81
Obsessive-compulsive behavior
R46.89
Other symptoms and signs involving appearance and behavior

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical impact of the R46 category is significant as it allows healthcare providers to capture a wide range of symptoms that may indicate serious underlying conditions. This can lead to timely interventions and appropriate referrals to specialists. Administratively, accurate coding under R46 can influence quality measures and population health metrics, as it helps in tracking trends in behavioral and appearance-related health issues. As healthcare continues to evolve, understanding and utilizing R46 effectively can contribute to improved patient outcomes and more efficient healthcare delivery.

ICD-9 vs ICD-10

The clinical impact of the R46 category is significant as it allows healthcare providers to capture a wide range of symptoms that may indicate serious underlying conditions. This can lead to timely interventions and appropriate referrals to specialists. Administratively, accurate coding under R46 can influence quality measures and population health metrics, as it helps in tracking trends in behavioral and appearance-related health issues. As healthcare continues to evolve, understanding and utilizing R46 effectively can contribute to improved patient outcomes and more efficient healthcare delivery.

Reimbursement & Billing Impact

Reimbursement may vary based on the payer and the specific circumstances of the patient's presentation. It is advisable to check with individual payers for their specific billing requirements related to R46 codes, as some may have unique stipulations regarding documentation and coding practices.

Resources

Clinical References

  • •
    Official ICD-10 Guidelines for R46

Coding & Billing References

  • •
    Official ICD-10 Guidelines for R46

Frequently Asked Questions

What conditions are included in R46?

R46 includes symptoms such as abnormal appearance, altered behavior, and signs of disorientation or confusion. Specific examples may include abnormal gait, changes in personal hygiene, and other non-specific behavioral changes.

When should I use R46 codes?

R46 codes should be used when a patient presents with symptoms related to their appearance or behavior that do not fit into a more specific diagnosis. This can include initial visits where further evaluation is needed to determine the underlying cause.

What documentation is required for R46?

Documentation should include a detailed account of the patient's symptoms, any observed changes in behavior or appearance, and the clinical rationale for selecting the R46 code. It is important to note any additional assessments or tests that are planned.