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v1.0.0
ICD-10 Guide
ICD-10 CodesF64.0

F64.0

Billable

Transsexualism

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

Code Description

ICD-10 F64.0 is a billable code used to indicate a diagnosis of transsexualism.

Key Diagnostic Point:

Transsexualism, classified under ICD-10 code F64.0, refers to a condition where an individual experiences a strong and persistent identification with the opposite gender, leading to significant distress or impairment in social, occupational, or other important areas of functioning. This condition is characterized by a desire to transition to the opposite sex, which may involve social, legal, and medical changes, including hormone therapy and surgical interventions. Individuals with transsexualism often face challenges related to gender identity, which can lead to maladaptive behaviors and personality disorders, such as anxiety or depression, due to societal stigma and discrimination. The diagnosis requires a comprehensive evaluation by mental health professionals, who assess the individual's gender identity, history, and any co-occurring mental health conditions. It is crucial for healthcare providers to approach this condition with sensitivity and understanding, ensuring that the individual receives appropriate support and care throughout their transition process.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in patient presentation and experiences of gender dysphoria.
  • Need for comprehensive documentation of gender identity and transition history.
  • Potential co-occurring mental health disorders that may complicate diagnosis.
  • Variations in treatment protocols and standards of care across different providers.

Audit Risk Factors

  • Inadequate documentation of the patient's gender identity and transition history.
  • Failure to document co-occurring mental health conditions.
  • Lack of evidence for medical necessity of treatments related to transition.
  • Inconsistent coding practices among different providers.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

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

Common Clinical Scenarios

Evaluating patients seeking hormone therapy or surgical interventions for gender transition.

Billing Considerations

Understanding the impact of societal stigma on mental health and the importance of supportive therapy.

Endocrinology

Documentation Requirements

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

Common Clinical Scenarios

Managing hormone replacement therapy for individuals undergoing gender transition.

Billing Considerations

Awareness of the physical health implications of hormone therapy and the need for ongoing monitoring.

Coding Guidelines

Inclusion Criteria

Use F64.0 When
  • According to ICD
  • 10 guidelines, F64
  • 0 should be used when the individual meets the criteria for transsexualism, which includes a persistent desire to live as the opposite gender and significant distress related to their assigned gender
  • Documentation must support the diagnosis and any treatment provided

Exclusion Criteria

Do NOT use F64.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

HRT-001CPT Code

Hormone Replacement Therapy

Clinical Scenario

Used for patients undergoing gender transition requiring hormone therapy.

Documentation Requirements

Document the patient's informed consent and treatment plan.

Specialty Considerations

Endocrinologists must monitor hormone levels and adjust dosages accordingly.

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 accuracy of data collection and treatment planning for individuals with transsexualism.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of gender identity disorders, improving the accuracy of data collection and treatment planning for individuals with transsexualism.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of gender identity disorders, improving the accuracy of data collection and treatment planning for individuals with transsexualism.

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 transsexualism and gender dysphoria?

Transsexualism specifically refers to individuals who desire to transition to the opposite gender, while gender dysphoria encompasses a broader range of experiences related to discomfort with one's assigned gender.