R45.88 ICD-10-CM Code: Nonsuicidal self-harm

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for R45.88 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 R45.88 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for R45.88

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

Before you code R45.88

1. Check whether an established diagnosis that explains this sign or symptom is documented. If one is, review whether the documented diagnosis changes the coding pathway: a symptom that is integral to a confirmed diagnosis is not reported separately, while one not routinely associated with it may be. Signs and symptoms are reported when no definitive diagnosis is established (Guidelines I.B.4, I.B.5, I.B.6, I.C.18.b).

   Guide: Symptom code vs confirmed diagnosis →

Choose the right path

1. Is an established diagnosis that explains this sign or symptom documented?
   Yes → Review whether the documented diagnosis changes the coding pathway: a symptom integral to it is not reported separately.
   No → Continue — the sign or symptom code stands when no definitive diagnosis is established.

Consider R45.88. 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).

Official instructions as workflow

• Excludes2 — not part of R45.88(1 note)

  Coding workflow: The conditions named in this note are not included in R45.88. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  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.

  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 (4)

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.

• Injury, self-inflicted, without suicidal intent
• Self-harm (attempted), nonsuicidal
• Self-injury, nonsuicidal
• Self-mutilation (attempted), nonsuicidal

Don’t confuse R45.88 with…

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

The codes most likely to be picked instead of R45.88 — 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.

• F01— 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 symptoms and signs constituting part of a pattern of mental disorder adds F01; it is not part of this code and both may be reported when both are documented.

  Full comparison: R45.88 vs F01 →

• F99— 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 symptoms and signs constituting part of a pattern of mental disorder adds F99; it is not part of this code and both may be reported when both are documented.

  Full comparison: R45.88 vs F99 →

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.

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 R45.88 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 1 Excludes1 note: F07.0 — Personality change due to known physiological condition (via R45.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

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 883 (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):MBD012 — Suicidal ideation/attempt/intentional self-harm (default); EXT019 — External cause codes: unspecified mechanism; EXT021 — External cause codes: intent of injury, self-harm; INJ027 — Other unspecified injury.

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 CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Major Depression, Moderate or Severe, without Psychosis) for risk-adjusted payment.

F32.1 — Major depressive disorder, single episode, moderate, F32.2 — Major depressive disorder, single episode, severe without psychotic features, F33.1 — Major depressive disorder, recurrent, moderate, F33.2 — Major depressive disorder, recurrent severe without psychotic features, T14.91XA — Suicide attempt, initial encounter, T36.0X2A — Poisoning by penicillins, intentional self-harm, initial encounter, T36.1X2A — Poisoning by cephalosporins and other beta-lactam antibiotics, intentional self-harm, initial encounter, T36.2X2A — Poisoning by chloramphenicol group, intentional self-harm, initial encounter, T36.3X2A — Poisoning by macrolides, intentional self-harm, initial encounter, T36.4X2A — Poisoning by tetracyclines, intentional self-harm, initial encounter, T36.5X2A — Poisoning by aminoglycosides, intentional self-harm, initial encounter, T36.6X2A — Poisoning by rifampicins, intentional self-harm, initial encounter, T36.7X2A — Poisoning by antifungal antibiotics, systemically used, intentional self-harm, initial encounter, T36.8X2A — Poisoning by other systemic antibiotics, intentional self-harm, initial encounter, T36.92XA — Poisoning by unspecified systemic antibiotic, intentional self-harm, initial encounter, T36.AX2A — Poisoning by fluoroquinolone antibiotics, intentional self-harm, initial encounter, T37.0X2A — Poisoning by sulfonamides, intentional self-harm, initial encounter, T37.1X2A — Poisoning by antimycobacterial drugs, intentional self-harm, initial encounter, T37.2X2A — Poisoning by antimalarials and drugs acting on other blood protozoa, intentional self-harm, initial encounter, T37.3X2A — Poisoning by other antiprotozoal drugs, intentional self-harm, initial encounter, +350 more

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Schizophrenia, Psychosis, Except Schizophrenia, Personality Disorders; Anorexia/Bulimia Nervosa, Bipolar Disorders without Psychosis

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Suicidal ideation/attempt/intentional self-harm, External cause codes: unspecified mechanism, External cause codes: intent of injury, self-harm, Other unspecified injury).

O9A.211 — Injury, poisoning and certain other consequences of external causes complicating pregnancy, first trimester, O9A.212 — Injury, poisoning and certain other consequences of external causes complicating pregnancy, second trimester, O9A.213 — Injury, poisoning and certain other consequences of external causes complicating pregnancy, third trimester, O9A.219 — Injury, poisoning and certain other consequences of external causes complicating pregnancy, unspecified trimester, O9A.22 — Injury, poisoning and certain other consequences of external causes complicating childbirth, O9A.23 — Injury, poisoning and certain other consequences of external causes complicating the puerperium, S05.90XA — Unspecified injury of unspecified eye and orbit, initial encounter, S05.91XA — Unspecified injury of right eye and orbit, initial encounter, S05.92XA — Unspecified injury of left eye and orbit, initial encounter, S09.301A — Unspecified injury of right middle and inner ear, initial encounter, S09.302A — Unspecified injury of left middle and inner ear, initial encounter, S09.309A — Unspecified injury of unspecified middle and inner ear, initial encounter, S09.90XA — Unspecified injury of head, initial encounter, S09.91XA — Unspecified injury of ear, initial encounter, S09.92XA — Unspecified injury of nose, initial encounter, S09.93XA — Unspecified injury of face, initial encounter, S19.9XXA — Unspecified injury of neck, initial encounter, S29.9XXA — Unspecified injury of thorax, initial encounter, S39.91XA — Unspecified injury of abdomen, initial encounter, S39.92XA — Unspecified injury of lower back, initial encounter, +415 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Self-harm”; these codes share that main term but sit in a different category of the Tabular List.

Z81.8 — Family history of other mental and behavioral disorders (history, in family), Z91.51 — Personal history of suicidal behavior (history, suicidal), Z91.52 — Personal history of nonsuicidal self-harm (history, nonsuicidal)

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Thyroid Stimulating Hormone (TSH)

Contextual Map

Every relationship of R45.88 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 R45.88 with this related code in Claim Check

Hierarchy

• R00-R99 — Chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99) (R00-R99)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R40-R46 — Symptoms and signs involving cognition, perception, emotional state and behavior[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes1 notes

• F07.0 — Personality change due to known physiological condition[Excludes1](via R45.-): “signs and symptoms involving emotional state (R45.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• MBD012 — Suicidal ideation/attempt/intentional self-harm[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)
• EXT019 — External cause codes: unspecified mechanism[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)
• EXT021 — External cause codes: intent of injury, self-harm[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)
• INJ027 — Other unspecified injury[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

Risk adjustment (CMS-HCC)

• HCC 155 — Major Depression, Moderate or Severe, without Psychosis [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

• DRG 883 — DISORDERS OF PERSONALITY AND IMPULSE CONTROL[MS-DRG]: “DISORDERS OF PERSONALITY AND IMPULSE CONTROL (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

• Injury, self-inflicted, without suicidal intent[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Self-harm (attempted), nonsuicidal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Self-injury, nonsuicidal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Self-mutilation (attempted), nonsuicidal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (20)

• R45 — Symptoms and signs involving emotional state[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R45.0 — Nervousness[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R45.1 — Restlessness and agitation[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R45.2 — Unhappiness[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R45.3 — Demoralization and apathy[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R45.4 — Irritability and anger[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R45.5 — Hostility[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R45.6 — Violent behavior[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 12 more

Change history

• FY2022 — Added to the code set[Change history]— CMS release files (code change ledger) · icd10cm-fy2022

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

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

Risk adjustment Official source data

2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release 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 R45.88 in its code family, with their registry titles.

• R45.81 — Low self-esteem
• R45.82 — Worries
• R45.83 — Excessive crying of child, adolescent or adult
• R45.84 — Anhedonia
• R45.85 — Homicidal and suicidal ideations
• R45.850 — Homicidal ideations
• R45.851 — Suicidal ideations
• R45.86 — Emotional lability
• R45.87 — Impulsiveness
• R45.89 — Other symptoms and signs involving emotional state

View all codes in the R45 family