F43.12 Diagnosis Code – Chronic PTSD ICD-10 Guide

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Key Takeaways

  • F43.12 ICD-10 = Chronic Post-Traumatic Stress Disorder.
  • Billable code used for insurance reimbursement.
  • Based on DSM-5 PTSD criteria lasting >3 months.
  • Essential for mental health billing, VA disability claims, and therapy documentation.
  • Correct usage prevents denials and ensures compliance.

What Is F43.12 Diagnosis Code?

The F43.12 diagnosis code is an ICD-10 billable code used to classify Post-Traumatic Stress Disorder (PTSD), chronic.
This code applies when a patient’s PTSD symptoms last longer than 3 months and continue to interfere with daily functioning, relationships, or work.

Description (ICD-10-CM F43.12):

  • Chronic PTSD following exposure to a traumatic event.
  • Symptoms include flashbacks, nightmares, avoidance behaviors, hypervigilance, sleep disturbances, and persistent anxiety or depression.
  • Used by psychiatrists, psychologists, and primary care providers for diagnosis, treatment planning, and insurance reimbursement.

ICD-9 transition: Previously mapped to 309.81.

F43.12 Diagnosis Code Description

  • Condition: Post-Traumatic Stress Disorder, chronic
  • Type: Mental and behavioral disorder due to trauma
  • Billable: Yes, valid for reimbursement
  • Onset: Persists more than 3 months after the trauma
  • Applicable Providers: Psychiatrists, psychologists, primary care, mental health therapists

Clinical Context – When to Use F43.12

F43.12 is used when PTSD symptoms are long-term and ongoing, often following:

  • Military combat exposure
  • Physical or sexual assault
  • Severe accidents or natural disasters
  • Terrorist attacks or hostage situations
  • Repeated trauma or childhood abuse

F43.12 Diagnosis Criteria (DSM-5 Aligned)

To meet the F43.12 criteria, patients must exhibit:

  • Exposure to traumatic event(s).
  • Re-experiencing symptoms: intrusive memories, nightmares, or flashbacks.
  • Avoidance behaviors: avoiding reminders of trauma.
  • Negative mood/cognition changes: guilt, detachment, loss of interest.
  • Increased arousal: hyper vigilance, irritability, sleep problems.
  • Duration: Symptoms persist longer than 3 months.
  • Functional impairment in work, social, or personal life.

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F43.12 vs Related PTSD Codes

Code

Description

When Used

F43.10

PTSD, unspecified

Diagnosis not specified as acute/chronic

F43.11

Acute PTSD

Symptoms last <3 months

F43.12

Chronic PTSD

Symptoms persist >3 months

F43.20

Adjustment Disorder, unspecified

Stress-related, but not PTSD

F43.8

Other stress disorders

Covers other trauma responses

Billing & Reimbursement for F43.12

Since F43.12 is a billable ICD-10 code, it is:

  • Accepted by Medicare, Medicaid, VA disability, and private insurers.
  • Used in mental health billing claims for therapy, psychiatric evaluation, and medication management.
  • Often paired with CPT codes for psychotherapy (e.g., 90834, 90837) or medication management (99213, 99214).

Tip for providers: Always include detailed clinical documentation (trauma history, DSM-5 criteria met, treatment plan). Missing documentation can trigger denials.

Final Thoughts

ICD-10 code F43.12 plays a vital role in documenting and billing Chronic Post-Traumatic Stress Disorder (PTSD). Accurate use of this code not only ensures proper reimbursement but also supports patient care, disability evaluations, and compliance with DSM-5 criteria. Whether you’re a provider treating veterans, a psychiatrist managing long-term trauma care, or a billing specialist navigating payer policies, correct coding makes all the difference.

Cures Medical Billing specializes in simplifying complex behavioral health billing, reducing denials, and ensuring you get paid faster. Contact us today for a free consultation and let our experts handle your toughest coding and billing challenges.

Frequently Asked Questions (FAQs)

F43.12 is the ICD-10 code for Chronic Post-Traumatic Stress Disorder (PTSD), used when symptoms persist longer than 3 months.

Yes, F43.12 is a billable ICD-10-CM code used for insurance reimbursement, medical documentation, and VA disability claims.

  • 10: PTSD, unspecified.
  • 11: Acute PTSD (less than 3 months).
  • 12: Chronic PTSD (longer than 3 months).

Yes, veterans with chronic PTSD often have F43.12 listed in their medical documentation to support VA disability claims.

The DSM-5 requires trauma exposure plus persistent re-experiencing, avoidance, negative mood changes, hyperarousal, and impairment lasting 3+ months.

Common CPT codes include 90834 (psychotherapy, 45 minutes), 90837 (psychotherapy, 60 minutes), and 99213/99214 (psychiatric evaluation & management).

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