Quick reference
- When to use
- Use F43.10 when the client's presentation is directly linked to an identifiable stressor or traumatic event and meets the specific criteria for Post-Traumatic Stress Disorder. Document the qualifying event or stressor clearly.
- Duration
- PTSD: symptoms >1 month post-trauma. Acute Stress: 3 days to 1 month. Adjustment Disorders: onset within 3 months of stressor, resolves within 6 months after stressor ends. Reassess timeline regularly.
- Session codes
- Pair with CPT 90837 (60-min, preferred for trauma processing), 90834 (45-min for stabilization), or 90791 (initial evaluation). Add 96127 for PCL-5 or PHQ-9 screening. EMDR/exposure sessions often require 90837.
- Key indicators
- Intrusive memories or flashbacks • Avoidance of trauma reminders • Negative mood or cognition changes • Hyperarousal or hypervigilance • Sleep disturbance • Dissociative symptoms • Clear temporal link to stressor
What F43.10 represents
PTSD develops after exposure to actual or threatened death, serious injury, or sexual violence. The trauma can be directly experienced, witnessed, learned about (happening to a close family member or friend), or through repeated exposure to aversive details of traumatic events.
PTSD is not simply being upset about something bad that happened. It represents a fundamental disruption in how the brain processes and stores traumatic memories.
Key diagnostic criteria
Four symptom clusters (all required):
1. Intrusion symptoms (1+ required): intrusive memories, nightmares, flashbacks, psychological distress at reminders, physiological reactions to reminders
2. Avoidance (1+ required): avoidance of distressing memories/thoughts/feelings, avoidance of external reminders
3. Negative cognitions and mood (2+ required): inability to remember key aspects, persistent negative beliefs, distorted blame, persistent negative emotional state, diminished interest, detachment, inability to experience positive emotions
4. Arousal and reactivity (2+ required): irritable behavior, reckless/self-destructive behavior, hypervigilance, exaggerated startle, concentration problems, sleep disturbance
Duration: more than 1 month. Must cause significant distress or impairment.
Documentation essentials
Document the qualifying traumatic event (without unnecessary detail). Record symptoms from each cluster. Note duration and functional impact. Use PCL-5 for assessment.
Differential diagnosis
- Acute Stress Disorder (F43.0) – symptoms < 1 month
- Adjustment Disorder – stressor doesn't meet Criterion A
- GAD – hyperarousal without trauma history
- Panic Disorder – panic attacks without trauma context
- Dissociative disorders – may co-occur
Treatment planning
Evidence-based treatments:
- Prolonged Exposure (PE)
- Cognitive Processing Therapy (CPT)
- EMDR
- Written exposure therapy
- Medications: SSRIs (sertraline, paroxetine are FDA-approved)
Insurance & billing
F43.10 is well-accepted. Document trauma exposure and all four symptom clusters. Supports intensive treatment schedules.
Updates & changes
DSM-5 moved PTSD from anxiety disorders to trauma/stress disorders. DSM-5-TR provided additional clarifications.
Documentation pitfalls
Don't require the client to provide detailed trauma narrative in every session note. Do document which symptom clusters are endorsed. Always assess for dissociative subtype.
References
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).
- VA/DoD. (2023). Clinical Practice Guideline for the Management of PTSD and Acute Stress Disorder.