Quick reference
- When to use
- Use F42.3 when the client presents with obsessions, compulsions, or related symptoms consistent with Hoarding Disorder 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 F42.3 represents
Hoarding Disorder involves persistent difficulty discarding possessions, leading to cluttered living spaces that compromise their intended use. It causes significant distress and functional impairment.
Key diagnostic criteria
- Persistent difficulty discarding possessions
- Perceived need to save items and distress at discarding
- Accumulation of possessions that clutter living areas
- Clinically significant distress or impairment
- Not attributable to another medical condition
Specify: with excessive acquisition, with good/fair/poor/absent insight
Documentation essentials
Document degree of clutter, functional impact, insight level, and any safety concerns (fire hazards, health risks).
Differential diagnosis
Distinguish from OCD (hoarding as compulsion), MDD (hoarding from apathy), psychotic disorders, and neurocognitive disorders.
Treatment planning
Specialized CBT for hoarding. Motivational interviewing. Organizational skills training. Home visits when possible.
Insurance & billing
Recognized diagnosis. Document safety risks and functional impairment.
Updates & changes
New diagnosis in DSM-5, previously classified under OCD.
Documentation pitfalls
Don't dismiss as a lifestyle choice. Assess safety risks. Document insight level.
References
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).