Cracking the Code
Gender Identity Disorders
There has been confusion about how to accurately report the following diagnosis codes: F64.0 and F64.2. In October 2016, the ICD-10-CM coding guidance updated chapter 5, Behavioral and Neurodevelopmental Disorders (F01-F99) to reflect the most up-to-date information in the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5). In October 2016, category F64 was expanded with a new code F64.0, transsexualism. Per ICD-10-CM Tabular index, gender identity disorder in adolescence and adulthood and gender dysphoria in adolescents and adults falls under this diagnosis code as well. F64.2 captures gender identity disorder in childhood; gender dysphoria in children also falls under this diagnosis code.
To report the most appropriate diagnosis code, coders should pay very close attention to the documentation to ensure accuracy and coding to highest level of specificity. If the provider documents transsexualism, gender identity disorder, or gender dysphoria in adolescence and adulthood, then it is appropriate to assign F64.0. If the provider documents gender identity disorder or dysphoria in children, then it is appropriate to assign F64.2.
Q: A 7-year-old patient and their parent present to the psychiatric facility with concerns for anxiety and depression. Parent states their child is often bullied at school for wearing dresses. The patient has never identified as male despite being assigned it at birth. After psychological testing was completed, the psychiatrist has a final impression of gender dysphoria in children.
A: F64.2, gender identity disorder in childhood
Reference: AHA Coding Clinic Fourth Quarter 2016, page 14: ICD-10-CM New/Revised Codes: Behavioral and Neurodevelopmental Disorders