ICD-10 Coding for Agoraphobia(F40.01, F40.02, F40.00)
Complete ICD-10-CM coding and documentation guide for Agoraphobia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Agoraphobia
F40.00-F40.02Primary Range
Agoraphobia codes in ICD-10
These codes cover the spectrum of agoraphobia, including with and without panic disorder.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| F40.01 | Agoraphobia with panic disorder | Use when agoraphobia is linked with panic disorder and panic attacks occur outside of phobic situations. |
|
| F40.02 | Agoraphobia without panic disorder | Use when agoraphobia is present without any panic disorder. |
|
| F40.00 | Unspecified agoraphobia | Use only when initial assessment is incomplete and specific details are unavailable. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for agoraphobia with panic disorder
Essential facts and insights about Agoraphobia
Primary ICD-10-CM Codes for agoraphobia
Decision Criteria
clinical Criteria
- Panic attacks occur outside of agoraphobic situations
documentation Criteria
- Detailed notes on panic attack frequency and avoidance behaviors
Applicable To
- Agoraphobia with panic attacks
Excludes
- Panic disorder without agoraphobia (F41.0)
Clinical Validation Requirements
- Avoidance of ≥2 situations due to fear of panic-like symptoms
- Panic attacks occur unpredictably, not solely in phobic situations
- Symptoms cause significant distress or impairment
Code-Specific Risks
- Overuse without proper documentation of panic disorder
- Incorrect use when panic attacks are exclusive to phobic situations
Coding Notes
- Ensure documentation supports the presence of panic attacks outside of agoraphobic situations.
F40.02 - Agoraphobia without panic disorder
Use when agoraphobia is present without any panic disorder.
Applicable To
- Agoraphobia without panic attacks
Excludes
- Panic disorder with agoraphobia (F40.01)
Clinical Validation Requirements
- Avoidance exists without panic attacks
- Fear of situations like incontinence or social scrutiny
Coding Notes
Ensure documentation clearly indicates the absence of panic attacks.
F40.00 - Unspecified agoraphobia
Use only when initial assessment is incomplete and specific details are unavailable.
Clinical Validation Requirements
- Used as a temporary placeholder during initial assessments
Coding Notes
Avoid using this code for more than 3 months without justification.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Agoraphobia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F40.01.
Impact
Clinical: Leads to inappropriate treatment plans., Regulatory: Triggers audit queries., Financial: May result in claim denials.
Mitigation Strategy
Always specify if panic disorder is present., Use detailed progress notes.
Impact
Reimbursement: May lead to denied claims or reduced payments., Compliance: Increases risk of audits., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Ensure detailed documentation to support specific codes like F40.01 or F40.02.
Impact
Frequent use of F40.00 without justification.
Mitigation Strategy
Ensure detailed documentation and use specific codes when possible.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Agoraphobia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Agoraphobia
Use these documentation templates to ensure complete and accurate documentation for Agoraphobia. These templates include all required elements for proper coding and billing.
Agoraphobia with panic disorder
Specialty: PsychiatryRequired Elements
- Avoidance behaviors
- Panic attack frequency
- Functional impact
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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