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v1.0.0
ICD-10 Guide
ICD-10 CodesF40.0

F40.0

Billable

Agoraphobia

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

Code Description

ICD-10 F40.0 is a billable code used to indicate a diagnosis of agoraphobia.

Key Diagnostic Point:

Agoraphobia is characterized by an intense fear or anxiety about being in situations where escape might be difficult or help unavailable in the event of a panic attack or similar incapacitating symptoms. Individuals with agoraphobia often avoid public places, crowds, or situations that may provoke feelings of helplessness or embarrassment. This condition can significantly impair daily functioning and quality of life, leading to social isolation. The onset of agoraphobia typically occurs in late adolescence or early adulthood, although it can develop at any age. It is often associated with panic disorder, where individuals may experience recurrent panic attacks. Treatment options include cognitive-behavioral therapy (CBT), exposure therapy, and medications such as selective serotonin reuptake inhibitors (SSRIs). Effective management requires a comprehensive approach that addresses both the psychological and physiological aspects of anxiety disorders.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between agoraphobia and other anxiety disorders.
  • Understanding the comorbidity with panic disorder.
  • Variability in symptom presentation among patients.
  • Need for thorough documentation of patient history and symptoms.

Audit Risk Factors

  • Inadequate documentation of symptoms and their impact on daily life.
  • Failure to note comorbid conditions such as panic disorder.
  • Lack of evidence for treatment plans and patient progress.
  • Misclassification of agoraphobia as a general anxiety disorder.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with panic attacks in public settings, avoidance behaviors, and social withdrawal.

Billing Considerations

Consideration of comorbid mental health conditions and the need for a multidisciplinary approach.

Primary Care

Documentation Requirements

Comprehensive assessment of anxiety symptoms, referral notes, and follow-up care documentation.

Common Clinical Scenarios

Patients reporting anxiety about leaving home or attending social events.

Billing Considerations

Coordination with mental health specialists for integrated care.

Coding Guidelines

Inclusion Criteria

Use F40.0 When
  • According to ICD
  • 10 guidelines, F40
  • 0 should be used when the primary diagnosis is agoraphobia without panic disorder
  • It is essential to document the specific symptoms and their impact on the patient's life

Exclusion Criteria

Do NOT use F40.0 When
  • Exclusion criteria include situations where anxiety is better explained by another mental disorder

Related ICD-10 Codes

Related CPT Codes

90834CPT Code

Psychotherapy, 45 minutes with patient

Clinical Scenario

Used for therapy sessions addressing agoraphobia symptoms.

Documentation Requirements

Session notes detailing patient progress and treatment response.

Specialty Considerations

Psychiatrists should document specific therapeutic techniques used.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of agoraphobia, improving the ability to capture the nuances of the disorder and its impact on patient care. This specificity aids in better treatment planning and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of agoraphobia, improving the ability to capture the nuances of the disorder and its impact on patient care. This specificity aids in better treatment planning and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of agoraphobia, improving the ability to capture the nuances of the disorder and its impact on patient care. This specificity aids in better treatment planning and resource allocation.

Resources

Clinical References

  • •
    National Institute of Mental Health

Coding & Billing References

  • •
    National Institute of Mental Health

Frequently Asked Questions

What is the difference between agoraphobia and panic disorder?

Agoraphobia is characterized by fear of situations where escape may be difficult, often leading to avoidance behavior. Panic disorder involves recurrent panic attacks, which may or may not lead to agoraphobia. It is important to document both conditions accurately if they coexist.