F42.2 ICD-10-CM Code: Mixed obsessional thoughts and acts
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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders (F40-F48)
F42.2
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceMixed obsessional thoughts and acts
This condition involves both obsessive thoughts (unwanted, intrusive ideas) and compulsive behaviors (repetitive actions performed to relieve anxiety from the thoughts).
Buddy Insight
Mixed obsessional thoughts and acts is a form of obsessive-compulsive disorder where the patient exhibits both obsessional thinking and compulsive behaviors without one clearly predominating.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
MappedHCC 133
RAF 0.035
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for F42.2 in this effective period.
Excludes 2
Official- obsessive-compulsive personality (disorder) (F60.5)
- obsessive-compulsive symptoms occurring in depression (F32.-, F33.-)
- obsessive-compulsive symptoms occurring in schizophrenia (F20.-)
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for F42.2 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for F42.2 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for F42.2 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for F42.2 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for F42.2 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is F42.2 an HCC code?
F42.2 is not in the CMS-HCC V28 or V24 community payment model, but it does map to Personality Disorders, Anxiety, and Other Specified Mental Disorders under the Part D RxHCC model.
- Code
- F42.2
- Description
- Mixed obsessional thoughts and acts
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.
Work F42.2 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for F42.2
For F42.2 to 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 F42.2 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
F42.2 is the ICD-10-CM diagnosis code for mixed obsessional thoughts and acts. This condition involves both obsessive thoughts (unwanted, intrusive ideas) and compulsive behaviors (repetitive actions performed to relieve anxiety from the thoughts). F42.2 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).
F42.2 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.
This code does not map to a CMS-HCC V28 payment category. Capture depends on documentation that supports the diagnosis; verify the HCC assignment against the current CMS mapping for the applicable payment year. Coders reviewing F42.2 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 F42.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document both the obsessive thoughts and the compulsive acts to support this specific diagnosis
- •Confirm that the patient recognizes the thoughts as irrational or excessive
Clinical Significance
Mixed obsessional thoughts and acts is a form of obsessive-compulsive disorder where the patient exhibits both obsessional thinking and compulsive behaviors without one clearly predominating. This is the most common presentation of OCD. It does not map to any HCC and is not risk-adjusting, though OCD can cause significant functional impairment requiring intensive treatment.
Documentation Requirements
- ✓Obsessional thoughts documented (e.g., contamination fears, symmetry/ordering, harm/aggression, religious/sexual obsessions)
- ✓Compulsive behaviors documented (e.g., washing, checking, counting, arranging)
- ✓Both obsessions and compulsions are present and neither clearly predominates
- ✓Time consumed by obsessions and compulsions (typically 1+ hour per day for clinical significance)
- ✓Functional impairment and distress caused by symptoms
- ✓Current treatment (cognitive-behavioral therapy with exposure and response prevention, SSRIs, etc.)
Commonly Confused Codes
- •F42.8 (Other obsessive-compulsive disorder): Use F42.8 when obsessions or compulsions predominate or for atypical OCD presentations
- •F42.9 (Obsessive-compulsive disorder, unspecified): Use F42.2 when both thoughts and acts are documented; F42.9 is for when the presentation is not specified
- •F42.3 (Hoarding disorder): Hoarding is a separate OCD-related disorder with its own code
- •F42.4 (Excoriation disorder): Skin-picking is a separate OCD-related disorder
- •F63.3 (Trichotillomania): Hair-pulling disorder is in the impulse control chapter but is OCD-related