F45.42 ICD-10-CM Code: Pain disorder with related psychological factors

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for F45.42 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on F45.42 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for F45.42

MedCoder structured workflow — derived from this code’s own official record

Before you code F45.42

1. F45.42’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

   Guide: Combination codes →

2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with F45.42. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

   See the official tabular notes

Choose the right path

1. Does the documentation support a condition named in F45.42’s Excludes1 note?
   Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
   No → Continue.

   ReviewR52

Consider F45.42. Then review the Code Also note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

The associated condition or complication

Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).

Official instructions as workflow

• Excludes1 — check before selecting F45.42(1 note)

  Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with F45.42: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

  CompareR52

  See the official tabular notes · Guidelines I.A.12.a

• Excludes2 — not part of F45.42(13 notes)

  Coding workflow: The conditions named in this note are not included in F45.42. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareF44, F68.1, F68.A, F63.3, F80.0, F98.8

  See the official tabular notes · Guidelines I.A.12.b

• Code Also — related condition(1 note)

  Coding workflow: Review the related condition when both are documented and the instruction applies. A Code Also note does not fix sequencing; the order follows the circumstances of the encounter.

  ReviewG89

  See the official tabular notes · Guidelines I.A.17

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Indexed Clinical Terms (1)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

• Disorder (of), pain, with related psychological factors

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Don’t confuse F45.42 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of F45.42 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• R52— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of pain NOS moves the case to R52; the two are not reported together unless documented as unrelated.

  Full comparison: F45.42 vs R52 →

• F44— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of dissociative and conversion disorders adds F44; it is not part of this code and both may be reported when both are documented.

  Full comparison: F45.42 vs F44 →

• F68.1— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of factitious disorders adds F68.1; it is not part of this code and both may be reported when both are documented.

  Full comparison: F45.42 vs F68.1 →

• F68.A— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of factitious disorders adds F68.A; it is not part of this code and both may be reported when both are documented.

  Full comparison: F45.42 vs F68.A →

• F63.3— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of hair-plucking adds F63.3; it is not part of this code and both may be reported when both are documented.

  Full comparison: F45.42 vs F63.3 →

• F80.0— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of lalling adds F80.0; it is not part of this code and both may be reported when both are documented.

  Full comparison: F45.42 vs F80.0 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

1. 1 Code Also note — a second code may apply; the guidelines leave its sequencing to the circumstances of the encounter. See the Code Also notes
2. 1 Excludes1 entry — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
3. 13 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

• No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name F45.42 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 2 Excludes2 notes: F41 — Other anxiety disorders (via F45.-), F93.0 — Separation anxiety disorder of childhood (via F45.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 1 Code Also instruction: G89 — Pain, not elsewhere classified.

These codes suggest coding this condition alongside when both are present.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 1 MS-DRG: DRG 882 (MDC 19).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):MBD011 — Somatic disorders (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Somatic disorders).

F45.0 — Somatization disorder, F45.1 — Undifferentiated somatoform disorder, F45.20 — Hypochondriacal disorder, unspecified, F45.21 — Hypochondriasis, F45.29 — Other hypochondriacal disorders, F45.41 — Pain disorder exclusively related to psychological factors, F45.8 — Other somatoform disorders, F45.9 — Somatoform disorder, unspecified, F68.10 — Factitious disorder imposed on self, unspecified, F68.11 — Factitious disorder imposed on self, with predominantly psychological signs and symptoms, F68.12 — Factitious disorder imposed on self, with predominantly physical signs and symptoms, F68.13 — Factitious disorder imposed on self, with combined psychological and physical signs and symptoms, F68.A — Factitious disorder imposed on another

Contextual Map

Every relationship of F45.42 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run F45.42 with these 3 related codes in Claim Check

Hierarchy

• F01-F99 — Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99) (F01-F99)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• F40-F48 — Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Code Also

• G89 — Pain, not elsewhere classified[Code Also]: “associated acute or chronic pain (G89.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Excludes2 notes

• F41 — Other anxiety disorders[Excludes2](via F45.-): “psychophysiologic disorders (F45.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• F93.0 — Separation anxiety disorder of childhood[Excludes2](via F45.-): “nonpsychotic mental disorders (F40-F48)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Code Also instructions

• G89 — Pain, not elsewhere classified[Code Also]: “related psychological factors associated with pain (F45.42)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• MBD011 — Somatic disorders[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• DRG 882 — NEUROSES EXCEPT DEPRESSIVE[MS-DRG]: “NEUROSES EXCEPT DEPRESSIVE (MDC 19)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 19 — Mental Diseases and Disorders[MDC crossing]: “Mental Diseases and Disorders — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

• Disorder (of), pain, with related psychological factors[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (12)

• F45 — Somatoform disorders[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• F45.0 — Somatization disorder[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• F45.1 — Undifferentiated somatoform disorder[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• F45.2 — Hypochondriacal disorders[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• F45.20 — Hypochondriacal disorder, unspecified[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• F45.21 — Hypochondriasis[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• F45.22 — Body dysmorphic disorder[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• F45.29 — Other hypochondriacal disorders[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 4 more

Change history

• FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Coding guidelines Official source data

ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to F45.42 in its code family, with their registry titles.

• F45.1 — Undifferentiated somatoform disorder
• F45.2 — Hypochondriacal disorders
• F45.20 — Hypochondriacal disorder, unspecified
• F45.21 — Hypochondriasis
• F45.22 — Body dysmorphic disorder
• F45.29 — Other hypochondriacal disorders
• F45.4 — Pain disorders related to psychological factors
• F45.41 — Pain disorder exclusively related to psychological factors
• F45.8 — Other somatoform disorders
• F45.9 — Somatoform disorder, unspecified

View all codes in the F45 family