ICD-10 Coding for Behavioral Problem(F91.3, F43.24)
Complete ICD-10-CM coding and documentation guide for Behavioral Problem. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Behavioral Problem
F90-F98Primary Range
Behavioral and emotional disorders with onset usually occurring in childhood and adolescence
This range includes codes for various behavioral disorders commonly diagnosed in children and adolescents, such as ADHD and conduct disorders.
Persons with potential health hazards related to socioeconomic and psychosocial circumstances
These codes are used to provide context for behavioral problems related to environmental and social factors.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| F91.3 | Oppositional defiant disorder | Use when a patient exhibits persistent oppositional behavior that meets DSM-5 criteria. |
|
| F43.24 | Adjustment disorder with mixed disturbance of emotions and conduct | Use when symptoms are a direct response to a specific stressor and cause significant impairment. |
|
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 oppositional defiant disorder
Essential facts and insights about Behavioral Problem
Primary ICD-10-CM Codes for behavioral problem
Decision Criteria
clinical Criteria
- Presence of ≥4 DSM-5 criteria for ODD
documentation Criteria
- Behavior observed in multiple settings
Applicable To
- Recurrent pattern of angry/irritable mood
- Argumentative/defiant behavior
Clinical Validation Requirements
- ≥4 DSM-5 ODD criteria for ≥6 months
- Observed in multiple settings (home/school)
Code-Specific Risks
- Misclassification with conduct disorder
- Inadequate documentation of settings
Coding Notes
- Ensure documentation includes specific DSM-5 criteria met by the patient.
F43.24 - Adjustment disorder with mixed disturbance of emotions and conduct
Use when symptoms are a direct response to a specific stressor and cause significant impairment.
Applicable To
- Clinically significant distress
- Impairment in social/occupational functioning
Excludes
- Major depressive disorder (F32.-)
Clinical Validation Requirements
- Symptom onset within 3 months of identifiable stressor
- No prior psychiatric history
Coding Notes
Document the specific stressor and the timeline of symptom onset.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
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 Behavioral Problem to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F91.3.
Impact
Clinical: May lead to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials or reduced reimbursement.
Mitigation Strategy
Document specific stressor and timeline, Ensure linkage between stressor and symptoms
Impact
Reimbursement: May lead to claim denials due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Poor data quality affecting patient care and research.
Mitigation Strategy
Ensure documentation includes specific behaviors and settings.
Impact
Use of unspecified codes without adequate documentation.
Mitigation Strategy
Ensure detailed documentation of behaviors and settings.
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 Behavioral Problem, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Behavioral Problem
Use these documentation templates to ensure complete and accurate documentation for Behavioral Problem. These templates include all required elements for proper coding and billing.
Adolescent with oppositional behavior
Specialty: PsychiatryRequired Elements
- Presenting problem
- History of present illness
- Mental status exam
- Diagnosis
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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