F40.00
BillableAgoraphobia, unspecified
HCC Category Mapping
RxHCCHCC 133 — Personality Disorders, Anxiety, and Other Specified Mental Disorders
0.000What This Code Means
An anxiety disorder where a person has intense fear and avoidance of open or crowded spaces, public transportation, or situations where escape might be difficult.
Coding Tips
- •Agoraphobia can occur with or without panic disorder; F40.00 is used when panic disorder is not present
- •Document whether the agoraphobia is mild, moderate, or severe for clinical clarity
Clinical Significance
Agoraphobia, unspecified, describes a marked fear or avoidance of situations where escape might be difficult, such as open spaces, crowds, or being outside the home alone. This condition can be severely disabling, limiting patients' ability to access healthcare. It does not map to any HCC under V24 or V28, making it a non-risk-adjusting diagnosis, though it remains clinically important for care management.
Documentation Requirements
- ✓Marked fear or anxiety about two or more agoraphobic situations (public transportation, open spaces, enclosed places, standing in line/crowds, being outside the home alone)
- ✓Duration of symptoms (typically 6+ months)
- ✓Avoidance behaviors and their impact on daily functioning
- ✓Distinction from panic disorder (document whether panic attacks are present or absent)
- ✓Differential diagnosis ruling out social anxiety, specific phobias, or other anxiety disorders
- ✓Current treatment plan including cognitive-behavioral therapy and/or pharmacotherapy
Commonly Confused Codes
F40.01 (Agoraphobia with panic disorder) — Use F40.01 when panic attacks occur in agoraphobic situations; F40.00 does not specify panic disorder presenceF40.02 (Agoraphobia without panic disorder) — Use F40.02 when documentation explicitly states no panic disorder; F40.00 is for unspecified casesF41.0 (Panic disorder) — Panic disorder can exist without agoraphobia; distinguish based on whether situational avoidance is the primary featureF40.10 (Social phobia, unspecified) — Social phobia involves fear of social evaluation; agoraphobia involves fear of situations where escape is difficult
Code Hierarchy
└F40Phobic anxiety disorders└F40.0Agoraphobia└F40.00Agoraphobia, unspecified
└F40.00Agoraphobia, unspecified