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v1.0.0
ICD-10 Guide
ICD-10 CodesF43.20

F43.20

Billable

Adjustment disorder, unspecified

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

Code Description

ICD-10 F43.20 is a billable code used to indicate a diagnosis of adjustment disorder, unspecified.

Key Diagnostic Point:

Adjustment disorder, unspecified, is a mental health condition that arises in response to a significant life stressor or change, such as loss of a loved one, divorce, job loss, or other major life transitions. This disorder is characterized by emotional or behavioral symptoms that develop within three months of the stressor and can include anxiety, depression, and difficulty coping. Unlike other anxiety disorders, PTSD, or OCD, adjustment disorders are typically transient and resolve once the individual adapts to the new situation or the stressor is removed. Symptoms may manifest as feelings of sadness, hopelessness, anxiety, or irritability, and can lead to functional impairment in social, occupational, or other important areas of functioning. The unspecified designation indicates that the specific nature of the symptoms does not fit neatly into the defined categories of adjustment disorders, allowing for flexibility in diagnosis and treatment. Treatment often involves psychotherapy, stress management techniques, and, in some cases, medication to alleviate symptoms.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in symptom presentation
  • Overlap with other mental health disorders
  • Need for thorough documentation of stressors
  • Potential for misdiagnosis with anxiety disorders

Audit Risk Factors

  • Inadequate documentation of stressors
  • Failure to specify the nature of symptoms
  • Misalignment between diagnosis and treatment provided
  • Inconsistent coding across providers

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed patient history, including stressors and symptom onset, treatment plans, and progress notes.

Common Clinical Scenarios

Patients experiencing life changes such as divorce, job loss, or bereavement.

Billing Considerations

Ensure that the diagnosis is supported by clear documentation of the stressor and its impact on the patient's functioning.

Primary Care

Documentation Requirements

Comprehensive assessment of mental health status, including screening for anxiety and depression.

Common Clinical Scenarios

Patients presenting with somatic complaints related to stress or anxiety.

Billing Considerations

Collaboration with mental health specialists may be necessary for comprehensive care.

Coding Guidelines

Inclusion Criteria

Use F43.20 When
  • According to ICD
  • 10 guidelines, adjustment disorders are classified under F43
  • 2 and require documentation of the stressor and the symptoms that arise in response
  • The unspecified code is used when the specific nature of the symptoms is not clearly defined

Exclusion Criteria

Do NOT use F43.20 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

90834CPT Code

Psychotherapy, 45 minutes with patient.

Clinical Scenario

Used for therapy sessions addressing adjustment disorder symptoms.

Documentation Requirements

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

Specialty Considerations

Psychiatrists and psychologists should ensure that the diagnosis aligns with the treatment provided.

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 adjustment disorders. This has improved the ability to track and manage these conditions more effectively in clinical practice.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of mental health conditions, including adjustment disorders. This has improved the ability to track and manage these conditions more effectively in clinical practice.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of mental health conditions, including adjustment disorders. This has improved the ability to track and manage these conditions more effectively in clinical practice.

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 difference between adjustment disorder and anxiety disorder?

Adjustment disorder is specifically triggered by identifiable stressors and is typically transient, while anxiety disorders can occur without a clear external cause and may be chronic.