Quick reference
- When to use
- Use F42.2 when the client presents with obsessions, compulsions, or related symptoms consistent with Obsessive-Compulsive Disorder, Mixed that are time-consuming (>1 hour/day) or cause significant distress or impairment. Specify insight level.
- Duration
- No minimum duration specified in DSM-5, but symptoms should be persistent and not transient. Track severity with Y-BOCS at baseline and every 4-6 sessions. Document insight level (good/fair, poor, absent).
- Session codes
- Pair with CPT 90837 (60-min, preferred for ERP sessions). 90834 for maintenance. 90791 for initial evaluation. 96127 for Y-BOCS screening. Intensive programs may use 90837 multiple times per week.
- Key indicators
- Intrusive, unwanted thoughts (obsessions) • Repetitive behaviors or mental acts (compulsions) • Time-consuming rituals • Distress when unable to perform rituals • Insight varies • Significant functional impact
What F42.2 represents
The most common presentation of OCD, featuring both intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce anxiety. The obsessions and compulsions are time-consuming and cause significant distress.
Key diagnostic criteria
- Presence of obsessions, compulsions, or both
- Obsessions: recurrent, persistent, intrusive thoughts/urges/images causing marked anxiety
- Compulsions: repetitive behaviors/mental acts performed in response to obsessions or rigid rules
- Time-consuming (>1 hour/day) or cause significant distress/impairment
- Not attributable to substance use or medical condition
Specify insight level: good/fair, poor, absent/delusional
Documentation essentials
Document specific obsessions and compulsions. Rate severity with Y-BOCS. Note insight level. Record time spent on OCD behaviors.
Differential diagnosis
Distinguish from GAD (worry vs. intrusive thoughts), body dysmorphic disorder, hoarding disorder, trichotillomania, and psychotic disorders.
Treatment planning
ERP (Exposure and Response Prevention) is gold standard. SSRIs at higher doses. Combination ERP + SSRI most effective. Consider augmentation strategies.
Insurance & billing
F42.2 is well-accepted. Document severity and functional impact. May support intensive treatment programs.
Updates & changes
OCD has its own chapter in DSM-5 (separate from anxiety disorders).
Documentation pitfalls
Don't confuse OCD with OCPD. Always document insight level. Don't minimize the disorder.
References
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).