F43.10

Billable

Post-traumatic stress disorder, unspecified

HCC Category Mapping

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

0.000

What This Code Means

A mental health condition that develops after exposure to a traumatic event, characterized by intrusive memories, avoidance behaviors, and hyperarousal, without specification of whether it is acute or chronic.

Coding Tips

•Use this code only when the duration or onset pattern is not documented; specify acute (F43.11) or chronic (F43.12) when information is available
•Document the traumatic event and symptoms present to support the diagnosis

Clinical Significance

Post-traumatic stress disorder, unspecified, is used when PTSD is documented without specification as acute or chronic. PTSD is a significant psychiatric condition that develops after exposure to traumatic events and involves re-experiencing, avoidance, negative cognitions/mood changes, and hyperarousal. It does not map to any HCC under V24 or V28 despite being a high-resource-utilization condition.

Documentation Requirements

✓Exposure to a traumatic event (actual or threatened death, serious injury, sexual violence)
✓Re-experiencing symptoms (intrusive memories, nightmares, flashbacks, distress at reminders)
✓Avoidance of trauma-related stimuli (thoughts, feelings, external reminders)
✓Negative alterations in cognitions and mood (amnesia, negative beliefs, detachment, diminished interest)
✓Alterations in arousal and reactivity (hypervigilance, exaggerated startle, irritability, sleep disturbance)
✓Duration of symptoms exceeding 1 month
✓Current treatment plan (trauma-focused CBT, EMDR, pharmacotherapy)

Commonly Confused Codes

F43.11 (Post-traumatic stress disorder, acute) — Use when symptoms have been present for less than 3 months following the traumatic event F43.12 (Post-traumatic stress disorder, chronic) — Use when symptoms have persisted for 3 months or longer F43.0 (Acute stress disorder) — Acute stress disorder occurs within 3 days to 1 month after trauma; PTSD requires symptoms beyond 1 month F43.20 (Adjustment disorder, unspecified) — Adjustment disorder involves less severe reactions to stressors that may not meet PTSD diagnostic criteria

Code Hierarchy

└F43Reaction to severe stress, and adjustment disorders └F43.1Post-traumatic stress disorder (PTSD)└F43.10Post-traumatic stress disorder, unspecified

└F43.10Post-traumatic stress disorder, unspecified