F45.42 — Pain disorder with related psychological factors
F45.42 is a billable, specific ICD-10-CM code for pain disorder with related psychological factors. It is valid for submission on a claim.
Code also
Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.
- associated acute or chronic pain (G89.-)
Risk adjustment
F45.42 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
F45.42 is named in 15 Medicare coverage policies — 14 listing it as supporting medical necessity, and 1 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
- A54799Billing and Coding: Urine Drug Testing
- A56619Billing and Coding: Nerve Conduction Studies and Electromyography
- A56645Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
How F45.42 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to F45.42.
- Disorder›pain›with related psychological factors
Related codes at this level
Codes that share F45.4. If F45.42 is not quite right, the correct code is usually one of these.
Questions about F45.42
- Is F45.42 a billable ICD-10-CM code?
- Yes. F45.42 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does F45.42 sit in the tabular list?
- Mental, Behavioral and Neurodevelopmental disorders (F01-F99), in the block Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders (F40-F48).