F42.2
BillableMixed obsessional thoughts and acts
HCC Category Mapping
RxHCCHCC 133 — Personality Disorders, Anxiety, and Other Specified Mental Disorders
0.000What This Code Means
This condition involves both obsessive thoughts (unwanted, intrusive ideas) and compulsive behaviors (repetitive actions performed to relieve anxiety from the thoughts).
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 presentationsF42.9 (Obsessive-compulsive disorder, unspecified) — Use F42.2 when both thoughts and acts are documented; F42.9 is for when the presentation is not specifiedF42.3 (Hoarding disorder) — Hoarding is a separate OCD-related disorder with its own codeF42.4 (Excoriation disorder) — Skin-picking is a separate OCD-related disorderF63.3 (Trichotillomania) — Hair-pulling disorder is in the impulse control chapter but is OCD-related