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ICD-10 Guide
ICD-10 CodesF43.81

F43.81

Billable

Prolonged grief disorder

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

Code Description

ICD-10 F43.81 is a billable code used to indicate a diagnosis of prolonged grief disorder.

Key Diagnostic Point:

Prolonged grief disorder (PGD) is characterized by an intense and persistent yearning for the deceased, accompanied by emotional pain and difficulty moving forward with life. This condition typically arises after the death of a loved one and is marked by symptoms that last for an extended period, often exceeding six months. Individuals with PGD may experience intrusive thoughts about the deceased, feelings of emptiness, and a sense of disbelief regarding the loss. They may also exhibit avoidance behaviors, such as steering clear of reminders of the deceased or avoiding social situations. Unlike typical grief, which gradually lessens over time, PGD can lead to significant impairment in daily functioning, including difficulties in work, social interactions, and self-care. The diagnosis requires a thorough clinical assessment to differentiate PGD from other mental health conditions, such as major depressive disorder or post-traumatic stress disorder (PTSD), which may share overlapping symptoms. Treatment often involves psychotherapy, including cognitive-behavioral therapy (CBT) and grief counseling, aimed at helping individuals process their grief and reintegrate into their lives.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating PGD from normal grief and other mental health disorders.
  • The need for comprehensive documentation of symptoms and duration.
  • Potential overlap with anxiety disorders and PTSD, complicating diagnosis.
  • Variability in symptom presentation among individuals.

Audit Risk Factors

  • Inadequate documentation of symptom duration.
  • Failure to differentiate PGD from other mental health disorders.
  • Lack of evidence for the impact of symptoms on daily functioning.
  • Insufficient clinical assessment notes.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed clinical notes outlining the patient's grief symptoms, duration, and impact on functioning.

Common Clinical Scenarios

Patients presenting with prolonged grief following the death of a spouse or child.

Billing Considerations

Consideration of co-occurring mental health disorders and their impact on treatment.

Psychology

Documentation Requirements

Thorough psychological assessments and treatment plans that address grief symptoms.

Common Clinical Scenarios

Individuals seeking therapy for unresolved grief issues.

Billing Considerations

Utilization of standardized grief assessment tools.

Coding Guidelines

Inclusion Criteria

Use F43.81 When
  • According to ICD
  • 10 guidelines, PGD is diagnosed when symptoms persist for more than six months and significantly impair daily functioning
  • It is essential to document the onset of symptoms and their impact on the patient's life

Exclusion Criteria

Do NOT use F43.81 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 prolonged grief symptoms.

Documentation Requirements

Session notes detailing the focus on grief processing.

Specialty Considerations

Psychiatrists and psychologists should document the therapeutic approach and patient progress.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of prolonged grief disorder, facilitating better tracking of this condition and its treatment in clinical settings.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of prolonged grief disorder, facilitating better tracking of this condition and its treatment in clinical settings.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of prolonged grief disorder, facilitating better tracking of this condition and its treatment in clinical settings.

Resources

Clinical References

  • •
    Prolonged Grief Disorder: A Guide for Clinicians

Coding & Billing References

  • •
    Prolonged Grief Disorder: A Guide for Clinicians

Frequently Asked Questions

What distinguishes prolonged grief disorder from normal grief?

Prolonged grief disorder is characterized by symptoms that persist for more than six months and significantly impair daily functioning, whereas normal grief typically lessens over time.