3 Things to Know When Coding for Post-Traumatic Stress Disorder
Coding for post-traumatic stress disorder (PTSD) should not be complicated if you know these three things:
- Know what to look for in the documentation, such as whether the condition is acute or chronic.
- Know how to find the correct code in the ICD-10-CM coding manual.
- Have an understanding of the coding guidelines as they apply to symptoms that are integral to the disease process.
Let’s consider these three points when coding for the exercise below.
PTSD Coding Exercise
Question: A 16-year-old female patient is seen today with complaints of severe anxiety, anger, flashbacks, and difficulty sleeping for four months. The patient was previously seen in the emergency room after sustaining a gunshot wound to the left shoulder. After an examination, the patient is diagnosed with post-traumatic stress disorder (PTSD). Assign the ICD-10-CM code for PTSD.
Then review the answer and rationale provided below. We also give some facts about PTSD and recent information about a new sibling code to PTSD released by the World Health Organization (WHO) for ICD-11.
ICD-10-CM Codes for PTSD
Post-traumatic stress disorder (PTSD) is reported with ICD-10-CM codes from Chapter 5. Mental, Behavioral, and Neurodevelopmental disorders (F01-F99), section F40-F48, Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders, category F43, Reaction to severe stress, and adjustment disorders.
The ICD-10-CM codes for PTSD are located in subcategory F43.1, Post-traumatic stress disorder, and include:
- F43.10, Post-traumatic stress disorder, unspecified
- F43.11, Post-traumatic stress disorder, acute
- F43.12, Post-traumatic stress disorder, chronic
Locate and Verify
Looking in the ICD-10-CM coding manual Index, see Disorder (of), post-traumatic stress (PTSD) F43.10.
When we go to this code in the Tabular List, we can verify the correct code as:
F43.10 Post-traumatic stress disorder, unspecified
The documentation does not specify if the PTSD is acute or chronic, so we need to go with the unspecified code.
We can now check off #1. Know what to look for in the documentation, such as whether the condition is acute or chronic.
We can also check off #2. Know how to find the correct code in the ICD-10-CM coding manual.
There is an inclusion term listed at F43.1. It is “Traumatic neurosis.” Therefore, if the documentation indicates the diagnosis is traumatic neurosis rather than PTSD and acute or chronic is not documented, we would still need to assign F43.10.
When we go to Neurosis, neurotic/traumatic in the Alphabetic Index, it takes us to F43.10. Verifying it in the Tabular takes us to F43.10, Post-traumatic stress disorder, unspecified.
Remember, we must go with the unspecified code here because the documentation does not indicate the PTSD is acute or chronic.
See the instructional notes at F01-F99 that state:
Includes: disorders of psychological development
Excludes2: symptoms, signs, and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)
You must always read these notes before making the final code selection because they are crucial to correct coding.
Coding Guidelines for Associated Symptoms
Based on the coding guidelines, there is no need to assign the symptoms here because anxiety, anger, flashbacks, and difficulty sleeping are all integral symptoms of PTSD.
According to the ICD-10-CM Official Guidelines for Coding and Reporting:
“Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes unless otherwise instructed by the classification.”
We can now check off #3. Have an understanding of the coding guidelines as they apply to symptoms that are integral to the disease process.
What is Post-Traumatic Stress Disorder?
According to the American Psychiatric Association, “Post-traumatic stress disorder (PTSD) is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault.”
PTSD is known in the military population. However, it is also becoming more prevalent in the general U.S. civilian population. According to Science Daily, traumatic events such as sexual abuse and domestic violence can cause PTSD. The recent mass shooting in Highland Park, Illinois, is just one example of domestic violence that affected many people in such a profound way during a 4th of July celebration. COVID-19 has also increased the number of cases of PTSD.
Symptoms of PTSD
Several of the following symptoms occur in PTSD and can vary in severity:
- Repeated, involuntary memories
- Distressing dreams
- Flashbacks of the event
- Avoidance of certain people, places, activities, objects, and situations
- Distorted beliefs about oneself
- Inability to recall parts of the event
- Constant fear, horror, anger, guilt, or shame
- Feeling of detachment
- Acting out in a self-destructive manner
- Easily startled
- Trouble concentrating or sleeping
Symptoms of PTSD often occur within three months of a traumatic event, but they may appear later. For a person to be diagnosed with PTSD, the symptoms must last for more than a month, and many times they persist for months or even years.
Not everyone who experiences trauma develops PTSD, and not everyone who experiences trauma or PTSD needs psychiatric treatment. Sometimes the symptoms will eventually disappear. Other times, the distress can be so severe that professional treatment is necessary. Such treatment as psychotherapy (talk therapy) and medication have proven effective for PTSD.
New Diagnosis and Code Released for ICD-11
The 11th revision to the WHO International Classification of Diseases (ICD-11) identified a new condition called complex post-traumatic stress disorder (CPTSD). CPTSD is a sibling condition to PTSD, and both conditions are reported with codes from the parent category of “Disorders specifically associated with stress.”
Currently, ICD-10 provides a broad description and includes many symptoms of PTSD. However, ICD-11 provides major changes to the diagnosis of PTSD and replaces it with two diagnoses, PTSD and CPTSD. According to the WHO, PTSD will be reported with code 6B40, and CPTSD will be reported with code 6B41.
ICD-11 Code Description for PTSD
The WHO describes post-traumatic stress disorder (6B40) in ICD-11 as:
“Post-traumatic stress disorder (PTSD) may develop following exposure to an extremely threatening or horrific event or series of events. It is characterized by all of the following: 1) re-experiencing the traumatic event or events in the present in the form of vivid intrusive memories, flashbacks, or nightmares. Re-experiencing may occur via one or multiple sensory modalities and is typically accompanied by strong or overwhelming emotions, particularly fear or horror, and strong physical sensations; 2) avoidance of thoughts and memories of the event or events, or avoidance of activities, situations, or people reminiscent of the event(s); and 3) persistent perceptions of heightened current threat, for example as indicated by hypervigilance or an enhanced startle reaction to stimuli such as unexpected noises. The symptoms persist for at least several weeks and cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”
ICD-11 Code Description for Complex PTSD
The WHO describes Complex post-traumatic stress disorder (6B41) in ICD-11 as:
“Complex post-traumatic stress disorder (Complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g., torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse). All diagnostic requirements for PTSD are met. In addition, Complex PTSD is characterized by severe and persistent 1) problems in affect regulation; 2) beliefs about oneself as diminished, defeated, or worthless, accompanied by feelings of shame, guilt, or failure related to the traumatic event; and 3) difficulties in sustaining relationships and in feeling close to others. These symptoms cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”
For now, we are only concerned with ICD-10. However, this article gives you a glimpse into what you can expect to see related to PTSD (and CPTSD) in ICD-11. As with anything in healthcare and medical coding, there will always be changes.