F43.12
BillablePost-traumatic stress disorder, chronic
HCC Category Mapping
RxHCCHCC 133 — Personality Disorders, Anxiety, and Other Specified Mental Disorders
0.000What This Code Means
Post-traumatic stress disorder that persists for more than 3 months after a traumatic event, with ongoing symptoms of re-experiencing, avoidance, and hyperarousal.
Coding Tips
- •Document that symptoms have been present for longer than 3 months to justify chronic coding
- •Include the date of the traumatic event and current symptom status in the medical record
Clinical Significance
Post-traumatic stress disorder, chronic, indicates PTSD symptoms persisting for 3 months or longer. Chronic PTSD often represents a more treatment-resistant course and is associated with greater functional impairment, higher rates of comorbid conditions (depression, substance use, chronic pain), and increased healthcare utilization. Despite its clinical severity, it does not map to any HCC.
Documentation Requirements
- ✓Documented exposure to a qualifying traumatic event
- ✓All four PTSD symptom clusters present and documented
- ✓Duration of symptoms 3 months or longer
- ✓Assessment of comorbid conditions (depression, substance use disorders, chronic pain)
- ✓Functional impairment across multiple life domains
- ✓Current treatment plan including trauma-focused therapy and/or pharmacotherapy
- ✓Documentation of treatment history and response
Commonly Confused Codes
F43.11 (Post-traumatic stress disorder, acute) — Acute PTSD is less than 3 months; chronic is 3+ monthsF43.10 (Post-traumatic stress disorder, unspecified) — Use F43.12 when chronicity is documentedF62.0 (Enduring personality change after catastrophic experience) — This represents a personality change following extreme trauma, distinct from PTSDF33.1 (Major depressive disorder, recurrent episode, moderate) — Comorbid depression should be coded separately from PTSD
Code Hierarchy
└F43Reaction to severe stress, and adjustment disorders└F43.1Post-traumatic stress disorder (PTSD)└F43.12Post-traumatic stress disorder, chronic
└F43.12Post-traumatic stress disorder, chronic