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ICD-10 Guide
ICD-10 CodesChapter 5: Mental, Behavioral and Neurodevelopmental disordersF64

F64

Billable

Gender identity disorders

Chapter 5:Mental, Behavioral and Neurodevelopmental disorders

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

Code Description

ICD-10 F64 is a billable code used to indicate a diagnosis of gender identity disorders.

Key Diagnostic Point:

Gender identity disorders encompass a range of conditions characterized by a marked incongruence between an individual's experienced or expressed gender and the gender assigned at birth. This incongruence can lead to significant distress or impairment in social, occupational, or other important areas of functioning. Individuals may experience a strong desire to be of the opposite gender, a strong preference for cross-dressing, or a strong conviction that they have the typical feelings and reactions of the opposite gender. These disorders are not classified as a mental illness but rather as a condition that may require medical intervention, including hormone therapy or gender-affirming surgeries. The diagnosis is made based on clinical assessment, including the duration of the incongruence and the degree of distress experienced. It is essential to differentiate gender identity disorders from other conditions, such as personality disorders or impulse control disorders, as the treatment and management strategies differ significantly. Understanding the nuances of gender identity is crucial for healthcare providers to offer appropriate support and care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in patient presentation and experiences of gender dysphoria
  • Need for comprehensive documentation of the patient's history and treatment plan
  • Potential overlap with other mental health conditions
  • Evolving standards of care and guidelines for treatment

Audit Risk Factors

  • Inadequate documentation of the patient's gender identity and treatment history
  • Failure to document the duration of gender dysphoria
  • Lack of evidence for medical necessity for treatments provided
  • Misclassification of gender identity disorders with other mental health conditions

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Thorough documentation of the patient's mental health history, gender identity, and any co-occurring mental health conditions.

Common Clinical Scenarios

Assessment of gender dysphoria, treatment planning for hormone therapy, and evaluation for gender-affirming surgeries.

Billing Considerations

Cultural competence and sensitivity in discussing gender identity with patients.

Endocrinology

Documentation Requirements

Detailed records of hormone therapy prescriptions, monitoring of hormone levels, and assessment of treatment effects.

Common Clinical Scenarios

Management of hormone replacement therapy for transgender patients.

Billing Considerations

Understanding the patient's gender identity and its impact on treatment decisions.

Coding Guidelines

Inclusion Criteria

Use F64 When
  • According to ICD
  • 10 guidelines, F64 codes are to be used when there is a clear diagnosis of gender identity disorder, supported by clinical documentation

Exclusion Criteria

Do NOT use F64 When
  • Exclusion criteria include conditions where gender dysphoria is secondary to a medical condition or substance use

Related CPT Codes

HRT-001CPT Code

Hormone Replacement Therapy

Clinical Scenario

Used for patients undergoing gender transition.

Documentation Requirements

Document the patient's informed consent and treatment goals.

Specialty Considerations

Endocrinologists should ensure ongoing monitoring of hormone levels.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of gender identity disorders, improving the ability to capture the nuances of these conditions and ensuring appropriate treatment and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of gender identity disorders, improving the ability to capture the nuances of these conditions and ensuring appropriate treatment and reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    World Professional Association for Transgender Health (WPATH)

Coding & Billing References

  • •
    World Professional Association for Transgender Health (WPATH)

Frequently Asked Questions

What is the difference between gender identity disorder and gender dysphoria?

Gender identity disorder is a broader term that encompasses various conditions related to gender identity, while gender dysphoria specifically refers to the distress experienced due to the incongruence between one's assigned gender and experienced gender.