What is ICD-10 code F40.231?

F40.231 is the ICD-10-CM diagnosis code for Fear of injections and transfusions. An intense fear of needles, injections, or blood transfusions that may prevent a person from seeking necessary medical care. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F40.231 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F40.231 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F40.231 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F40.231 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for F40.231?

F40.231 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards F40.231 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

What should coders know when reporting F40.231?

This is a blood-injection-injury type phobia Document specific triggers (needles, injections, transfusions) and impact on medical compliance

F40.231: Fear of injections and transfusions —

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupF40.231Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders (F40-F48)

F40.231

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Fear of injections and transfusions

An intense fear of needles, injections, or blood transfusions that may prevent a person from seeking necessary medical care.

Buddy Insight

CMS-HCC V28

Not risk-adjusted for this model/period.

RAF 0

CMS-HCC V24

Not risk-adjusted for this model/period.

RAF 0

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Not risk-adjusted for this model/period.

RAF 0

RXHCC

Mapped

HCC 133

Personality Disorders, Anxiet...

RAF 0.0

Code Trumping

Basket needed

Compare selected patient codes to show trumped or trumps impact.

Code Book Path

Official

F40.2Specific (isolated) phobias

F40.23Blood, injection, injury type phobia

F40.231Fear of injections and transfusions

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F40.231 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F40.231 in this effective period.

Related Child Codes

Official

F40.230Fear of blood

F40.232Fear of other medical care

F40.233Fear of injury

Includes

Official

ICD-10-CM does not list Includes notes for F40.231 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F40.231 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F40.231 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F40.231 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F40.231 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Marked fear or anxiety specifically about injections, needles, or transfusion procedures

Documentation of avoidance of necessary medical procedures due to the phobia

History of vasovagal responses during injection attempts if applicable

Duration of 6+ months

MEAT Support

HCC Buddy guidance

Marked fear or anxiety specifically about injections, needles, or transfusion procedures

Documentation of avoidance of necessary medical procedures due to the phobia

History of vasovagal responses during injection attempts if applicable

Duration of 6+ months

Audit Caution

HCC Buddy guidance

Confusing injection phobia with blood phobia — patients may have both, and each should be coded separately if documented

Failing to document the phobia as the reason for medication/vaccination noncompliance

Not recognizing needle phobia as a clinical condition when a patient simply states they 'don't like needles' without meeting phobia criteria

Using Z codes for noncompliance without identifying the underlying phobia

Common Mistakes

HCC Buddy guidance

F40.230 (Fear of blood) — Blood phobia is about seeing blood; needle phobia is about the injection/procedure itself

F40.232 (Fear of other medical care) — Broader medical phobia vs. specific needle/injection phobia

Z91.120 (Patient's intentional underdosing of medication regimen due to financial hardship) — Distinguish phobia-driven noncompliance from other reasons for medication nonadherence

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is F40.231 an HCC code?

No. F40.231 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.

HCC Category Mapping

RxHCCHCC 133, Personality Disorders, Anxiety, and Other Specified Mental Disorders

0.000

RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

MEAT Criteria for F40.231

For F40.231to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed F40.231 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

F40.231 is the ICD-10-CM diagnosis code for fear of injections and transfusions. An intense fear of needles, injections, or blood transfusions that may prevent a person from seeking necessary medical care. F40.231 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders (f40-f48).

F40.231 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

F40.231 does not map to any HCC under V24 or V28. No ESRD mapping. RxHCC maps to RxHCC 133 at 0.0 weight. Non-risk-adjusting but clinically significant for care planning. Coders reviewing F40.231 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for F40.231 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This is a blood-injection-injury type phobia
•Document specific triggers (needles, injections, transfusions) and impact on medical compliance

Clinical Significance

Fear of injections and transfusions (trypanophobia) is a blood-injection-injury subtype phobia that can significantly impact healthcare delivery by causing patients to avoid vaccinations, blood draws, intravenous medications, and surgical procedures. This phobia affects an estimated 10% of the population and can lead to serious health consequences when patients defer necessary medical care.

Documentation Requirements

✓Marked fear or anxiety specifically about injections, needles, or transfusion procedures
✓Documentation of avoidance of necessary medical procedures due to the phobia
✓History of vasovagal responses during injection attempts if applicable
✓Duration of 6+ months
✓Impact on healthcare compliance and treatment adherence
✓Management strategies (e.g., topical anesthetics, distraction techniques, desensitization therapy)

Commonly Confused Codes

•F40.230 (Fear of blood): Blood phobia is about seeing blood; needle phobia is about the injection/procedure itself
•F40.232 (Fear of other medical care): Broader medical phobia vs. specific needle/injection phobia
•Z91.120 (Patient's intentional underdosing of medication regimen due to financial hardship): Distinguish phobia-driven noncompliance from other reasons for medication nonadherence