ICD-10 code F43.10 designates PTSD, unspecified. Using the most accurate PTSD subcode — and understanding how it differs from adjustment disorder codes — protects your billing integrity and prevents unnecessary prior authorization delays.
The F43 PTSD Subcodes
- F43.10 — Post-traumatic stress disorder, unspecified. Use when PTSD is clearly present but duration has not been determined or does not clearly fall into acute or chronic.
- F43.11 — PTSD, acute. Symptoms present for less than 3 months after the traumatic event.
- F43.12 — PTSD, chronic. Symptoms persisting 3 months or more after the traumatic event.
In practice, most PTSD clients presenting for outpatient therapy have had symptoms for months or years — making F43.12 the most clinically accurate code for established PTSD cases.
F43.10/11/12 vs Adjustment Disorders (F43.20–F43.25)
Adjustment disorders occupy the same F43 block but represent a lower-severity stress response tied to an identifiable stressor:
- F43.20 — Adjustment disorder, unspecified
- F43.21 — With depressed mood
- F43.22 — With anxiety
- F43.23 — With mixed anxiety and depressed mood
- F43.24 — With disturbance of conduct
- F43.25 — With mixed disturbance of emotions and conduct
Key distinction: PTSD requires exposure to a qualifying traumatic event plus a specific symptom cluster (intrusion, avoidance, negative cognitions/mood, hyperarousal). Adjustment disorder involves a milder distress response to a stressor that does not meet full PTSD criteria.
Why Code Specificity Matters for Insurance
Some insurers flag F43.10/11/12 claims for prior authorization review, particularly for trauma-focused therapies like EMDR or Prolonged Exposure. Using the correct code from the start — supported by thorough documentation — reduces back-and-forth with payers.
Using an adjustment disorder code when PTSD criteria are clearly met is a documentation error that can affect continuity of care and insurance coverage decisions.
CPT Codes Paired With PTSD
PTSD treatment frequently involves longer, more intensive sessions:
- 90837 (60-minute individual therapy) — Standard for EMDR, Prolonged Exposure, or Cognitive Processing Therapy sessions
- 90834 (45-minute therapy) — Shorter follow-up or stabilization sessions
- 90791 (diagnostic evaluation) — Initial trauma assessment appointment
Prior Authorization for PTSD Treatment
Some payers require prior authorization for PTSD treatment, particularly for trauma-focused modalities. Check the client's plan benefits before beginning treatment. If prior auth is required, submit the request with the F43 subcode and clinical documentation of the traumatic exposure, symptom duration, and functional impact.
On the Superbill
Select the most specific F43 subcode that your documentation supports. For a client who has had PTSD symptoms for over a year, F43.12 is more accurate than F43.10. Superbilled accepts any ICD-10 code you enter.