What is ICD-10 code F43.25?

F43.25 is the ICD-10-CM diagnosis code for Adjustment disorder with mixed disturbance of emotions and conduct. A condition where a person develops emotional disturbances (such as anxiety or depression) combined with behavioral problems in response to a specific identifiable stressor. F43.25 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F43.25 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. F43.25 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. F43.25 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 F43.25?

F43.25 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 community model rewards F43.25 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. It does, however, map under the Part D RxHCC model (Personality Disorders, Anxiety, and Other Specified Mental Disorders), which affects the ESRD and/or Part D (RxHCC) risk scores. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

What should coders know when reporting F43.25?

Document both the emotional symptoms and the behavioral disturbances present Clearly identify the stressor and note that symptoms began within 3 months of the stressor onset

2026 ICD-10-CM F43.25: Adjustment disorder with mixed

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 lookupF43.25Effective 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)

F43.25

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

Adjustment disorder with mixed disturbance of emotions and conduct

A condition where a person develops emotional disturbances (such as anxiety or depression) combined with behavioral problems in response to a specific identifiable stressor.

Buddy Insight

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

Mapped

HCC 133

Personality Disorders, Anxiet...

RAF 0.035

Code Book Path

Official

F43Reaction to severe stress, and adjustment disorders

F43.2Adjustment disorders

F43.25Adjustment disorder with mixed disturbance of emotions and conduct

Inclusion Terms

Official

Culture shock
Grief reaction
Hospitalism in children

Excludes 2

Official

separation anxiety disorder of childhood (F93.0)

Related Child Codes

Official

F43.20Adjustment disorder, unspecified

F43.21Adjustment disorder with depressed mood

F43.22Adjustment disorder with anxiety

F43.23Adjustment disorder with mixed anxiety and depressed mood

F43.24Adjustment disorder with disturbance of conduct

Includes

Official

ICD-10-CM does not list Includes notes for F43.25 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F43.25 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F43.25 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F43.25 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F43.25 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Identifiable stressor documented

Both emotional symptoms (depression, anxiety) and conduct disturbance (behavioral problems) present

Neither emotional nor behavioral component alone meets criteria for another specific diagnosis

Symptom onset within 3 months of the stressor

MEAT Support

HCC Buddy guidance

Identifiable stressor documented

Both emotional symptoms (depression, anxiety) and conduct disturbance (behavioral problems) present

Neither emotional nor behavioral component alone meets criteria for another specific diagnosis

Symptom onset within 3 months of the stressor

Audit Caution

HCC Buddy guidance

Using F43.25 when only emotional or only behavioral symptoms are present — ensure both components are documented

Confusing this with disruptive mood dysregulation disorder (F34.81) in children — DMDD is chronic, not reactive

Not documenting the precipitating stressor

Continuing to use this diagnosis when symptoms persist well beyond the stressor resolution period

Common Mistakes

HCC Buddy guidance

F43.24 (Adjustment disorder with disturbance of conduct) — Use F43.24 when only conduct problems are present without emotional symptoms

F43.23 (Adjustment disorder with mixed anxiety and depressed mood) — Use F43.23 when emotional symptoms are present without conduct disturbance

F43.29 (Adjustment disorder with other symptoms) — Use F43.25 when the mixed emotional-behavioral pattern is clear

F91.9 (Conduct disorder, unspecified) — Conduct disorder is persistent and not reactive; adjustment disorder is time-limited

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 F43.25 an HCC code?

F43.25 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: F43.25
Description: Adjustment disorder with mixed disturbance of emotions and conduct
HCC (V28): No CMS-HCC V28 mapping
RAF: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

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

0.035

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 F43.25 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for F43.25

For F43.25 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 F43.25 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F43.25 is the ICD-10-CM diagnosis code for adjustment disorder with mixed disturbance of emotions and conduct. A condition where a person develops emotional disturbances (such as anxiety or depression) combined with behavioral problems in response to a specific identifiable stressor. F43.25 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).

F43.25 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 F43.25 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 F43.25 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document both the emotional symptoms and the behavioral disturbances present
•Clearly identify the stressor and note that symptoms began within 3 months of the stressor onset

Clinical Significance

Adjustment disorder with mixed disturbance of emotions and conduct captures reactive presentations where both emotional symptoms (depression, anxiety) and behavioral disturbances (aggression, rule-breaking) develop in response to an identifiable stressor. This combined presentation is common in adolescents dealing with significant life changes such as divorce, relocation, or loss.

Documentation Requirements

✓Identifiable stressor documented
✓Both emotional symptoms (depression, anxiety) and conduct disturbance (behavioral problems) present
✓Neither emotional nor behavioral component alone meets criteria for another specific diagnosis
✓Symptom onset within 3 months of the stressor
✓Functional impairment documented
✓Current treatment plan addressing both emotional and behavioral components

Commonly Confused Codes

•F43.24 (Adjustment disorder with disturbance of conduct): Use F43.24 when only conduct problems are present without emotional symptoms
•F43.23 (Adjustment disorder with mixed anxiety and depressed mood): Use F43.23 when emotional symptoms are present without conduct disturbance
•F43.29 (Adjustment disorder with other symptoms): Use F43.25 when the mixed emotional-behavioral pattern is clear
•F91.9 (Conduct disorder, unspecified): Conduct disorder is persistent and not reactive; adjustment disorder is time-limited