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ICD-10 Guide
ICD-10 CodesF40.00

F40.00

Billable

Agoraphobia, unspecified

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

Code Description

ICD-10 F40.00 is a billable code used to indicate a diagnosis of agoraphobia, unspecified.

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 trigger feelings of panic or anxiety. This condition can significantly impair daily functioning and quality of life. The unspecified designation indicates that the specific features of the agoraphobia have not been detailed, which may include the presence of panic disorder or other anxiety disorders. Treatment typically involves psychotherapy, particularly cognitive-behavioral therapy (CBT), and may include medications such as selective serotonin reuptake inhibitors (SSRIs). Understanding the nuances of agoraphobia is crucial for effective management and coding, as it often coexists with other anxiety disorders, including panic disorder, social anxiety disorder, and specific phobias.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in symptom presentation among patients
  • Potential overlap with other anxiety disorders
  • Need for detailed clinical documentation to support diagnosis
  • Differentiation from other phobias and anxiety disorders

Audit Risk Factors

  • Inadequate documentation of symptoms and history
  • Failure to specify the type of agoraphobia
  • Misclassification with other anxiety disorders
  • Lack of treatment documentation

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Comprehensive psychiatric evaluation, including patient history, symptom assessment, and treatment plan.

Common Clinical Scenarios

Patients presenting with panic attacks in public settings, avoidance behaviors, and comorbid anxiety disorders.

Billing Considerations

Ensure clear documentation of the impact of agoraphobia on daily functioning and any co-occurring mental health conditions.

Primary Care

Documentation Requirements

Detailed patient history, mental health screening results, and referral notes if applicable.

Common Clinical Scenarios

Patients reporting anxiety symptoms, avoidance of social situations, and requests for medication or therapy referrals.

Billing Considerations

Primary care providers should be aware of the need for mental health referrals and the importance of documenting the patient's functional status.

Coding Guidelines

Inclusion Criteria

Use F40.00 When
  • According to ICD
  • 10 coding guidelines, agoraphobia is classified under anxiety disorders
  • Coders must ensure that the diagnosis is supported by clinical documentation and that the unspecified designation is appropriate based on the patient's presentation

Exclusion Criteria

Do NOT use F40.00 When
  • Exclusion criteria include other specified anxiety disorders

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

Document the duration of the session, treatment goals, and patient progress.

Specialty Considerations

Psychiatrists should ensure that therapy notes reflect the specific issues related to agoraphobia.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more precise coding of agoraphobia, enabling better tracking of treatment outcomes and healthcare utilization. The specificity of ICD-10 codes helps in understanding the prevalence and management of anxiety disorders.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more precise coding of agoraphobia, enabling better tracking of treatment outcomes and healthcare utilization. The specificity of ICD-10 codes helps in understanding the prevalence and management of anxiety disorders.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more precise coding of agoraphobia, enabling better tracking of treatment outcomes and healthcare utilization. The specificity of ICD-10 codes helps in understanding the prevalence and management of anxiety disorders.

Resources

Clinical References

  • •
    American Psychiatric Association - Diagnostic and Statistical Manual of Mental Disorders

Coding & Billing References

  • •
    American Psychiatric Association - Diagnostic and Statistical Manual of Mental Disorders

Frequently Asked Questions

What is the difference between agoraphobia and panic disorder?

Agoraphobia is characterized by fear of situations where escape might be difficult, often related to panic attacks, while panic disorder involves recurrent unexpected panic attacks. Agoraphobia can occur with or without panic disorder.