Obsessive-compulsive disorder trips up more coders than its prevalence would suggest, because the single code most clinicians reach for, F42, is not billable on its own. OCD lives in the F42 family, and you have to pick the specific fourth-character code that matches the presentation. This guide covers every F42 code, the OCD-spectrum diagnoses that are easy to miscode, and how to code OCD alongside the anxiety and depression it so often travels with.
Quick Reference: OCD ICD-10 Codes
| Code | Description | Notes |
|---|---|---|
| F42.2 | Mixed obsessional thoughts and acts | Classic OCD; obsessions AND compulsions present |
| F42.3 | Hoarding disorder | Own diagnosis, not an OCD subtype |
| F42.4 | Excoriation (skin-picking) disorder | Body-focused repetitive behavior |
| F42.8 | Other obsessive-compulsive disorder | Meets OCD criteria but does not fit above |
| F42.9 | Obsessive-compulsive disorder, unspecified | Temporary placeholder only |
F42 is not billable. The category header F42 (obsessive-compulsive disorder) requires a fourth character. Submitting plain F42 will trigger a claim rejection for insufficient specificity. Always bill F42.2, F42.3, F42.4, F42.8, or F42.9.
Understanding OCD Diagnosis Codes
All OCD codes fall under the F42 category in ICD-10-CM. Two points catch clinicians who are used to a single "OCD" code:
- There is no plain "OCD" code. Classic OCD (obsessions and compulsions together) is F42.2, "mixed obsessional thoughts and acts." That is the code the DSM-5 crosswalk assigns to obsessive-compulsive disorder.
- F42.0 and F42.1 do not exist in ICD-10-CM. The WHO version of ICD-10 splits out predominantly obsessional thoughts (F42.0) and predominantly compulsive acts (F42.1), but the U.S. Clinical Modification does not use those codes. Do not bill them.
The billable F42 codes then branch into three distinct disorders that used to be grouped with OCD: hoarding (F42.3) and excoriation (F42.4) are their own diagnoses, with F42.8 and F42.9 as the "other" and "unspecified" catch-alls.
F42.2: Classic OCD (Mixed Obsessional Thoughts and Acts)
The short answer: the ICD-10 code for obsessive-compulsive disorder is F42.2.
When to use: the client has both obsessions (intrusive, unwanted thoughts, urges, or images) and compulsions (repetitive behaviors or mental acts performed to reduce distress). This is the correct code for the large majority of OCD presentations.
Documentation requirements:
- Presence of obsessions, compulsions, or both, with examples of content
- Time-consuming (typically more than one hour per day) or clinically significant distress or impairment
- Symptoms not better explained by another disorder (for example generalized worry, which points to F41.1)
- Degree of insight where relevant (good, poor, or absent)
Billing note: F42.2 is the workhorse OCD code. If you find yourself reaching for F42.9 routinely, your assessment is probably supporting F42.2 already; specify it.
F42.3: Hoarding Disorder
When to use: persistent difficulty discarding possessions regardless of value, driven by a perceived need to save items and distress at discarding them, resulting in clutter that compromises the use of living spaces.
Billing note: hoarding disorder is its own diagnosis, not an OCD subtype. Code it as F42.3 in its own right when hoarding is the primary presentation. Add a specifier in your documentation for excessive acquisition and level of insight if applicable.
F42.4: Excoriation (Skin-Picking) Disorder
When to use: recurrent skin picking resulting in lesions, with repeated attempts to stop, causing clinically significant distress or impairment.
Billing note: excoriation is a body-focused repetitive behavior on the OCD spectrum. Its close cousin, hair-pulling (trichotillomania), is coded elsewhere at F63.3, not in the F42 family. See the related-codes section below.
F42.8: Other Obsessive-Compulsive Disorder
When to use: the presentation meets OCD criteria but does not fit F42.2, F42.3, or F42.4. Examples include obsessional jealousy or other specified obsessive-compulsive presentations.
Billing note: use sparingly and document why the standard codes do not fit. Do not use F42.8 for body dysmorphic disorder, which has its own code (F45.22).
F42.9: Obsessive-Compulsive Disorder, Unspecified
When to use: OCD is clearly present but you do not yet have enough information to characterize the presentation, for example at an initial evaluation.
Billing note: treat F42.9 as a temporary placeholder. Payers increasingly flag unspecified codes, and patterns of F42.9 billing can trigger documentation requests. Move to F42.2 (or the specific F42 code) as soon as your assessment supports it.
OCD-Spectrum and Related Codes
Several conditions sit near OCD clinically but are coded outside the F42 family. Miscoding these is common, so keep this crosswalk handy:
| Code | Description | Notes |
|---|---|---|
| F45.22 | Body dysmorphic disorder | NOT an F42 code; classified under somatoform disorders |
| F63.3 | Trichotillomania (hair-pulling disorder) | Body-focused repetitive behavior |
| F95.2 | Tourette's disorder | Tics frequently co-occur with OCD |
| F42.8 | Other OCD (e.g. obsessional jealousy) | For OCD presentations outside F42.2 to F42.4 |
The most common OCD miscode: body dysmorphic disorder is F45.22, under somatoform disorders, not an F42 code. BDD is clinically on the obsessive-compulsive spectrum, but ICD-10-CM classifies it separately. Using an F42 code for BDD is a specificity error.
Coding OCD With Anxiety, Depression, and Tics
OCD rarely presents alone. There is no single combined code for OCD plus a comorbidity; you bill both codes and list the primary focus of treatment first. Common pairings:
| Code Pairing | Description | Notes |
|---|---|---|
| F42.2 + F41.1 | OCD with generalized anxiety disorder | Anxiety disorders are the most common OCD comorbidity |
| F42.2 + F40.10 | OCD with social anxiety disorder | Common when obsessions center on social evaluation |
| F42.2 + F32.x / F33.x | OCD with major depression | Depression often develops secondary to chronic OCD |
| F42.2 + F95.2 | OCD with Tourette's / tic disorder | Tic-related OCD, more common in childhood-onset cases |
| F42.2 + F84.0 | OCD with autism spectrum disorder | Distinguish true obsessions from ASD restricted interests |
When coding comorbidities, list the primary focus of treatment first, and document how each condition is being addressed so the pairing supports medical necessity.
OCD vs Generalized Anxiety Disorder
The most frequent OCD coding error is confusing it with generalized anxiety disorder (F41.1). The distinction drives the code:
- OCD (F42.2): discrete, intrusive, often ego-dystonic obsessions (contamination, symmetry, harm, taboo thoughts) paired with compulsions or mental rituals performed to neutralize them.
- GAD (F41.1): diffuse, realistic-themed worry (finances, health, work) across multiple domains, without ritualized compulsions.
When both are genuinely present, code both (F42.2 plus F41.1) rather than choosing one. If the worry is ritualized and content-specific, it is OCD; if it is free-floating worry about everyday concerns, it is GAD.
Documentation Tips
Strong OCD documentation should include:
Symptom content: specific obsessions and compulsions with examples, not just "OCD symptoms."
Time and impairment: how much time symptoms consume (the one-hour-per-day benchmark) and the concrete functional impact.
Insight level: good or fair, poor, or absent insight, which is a recognized specifier.
Differential reasoning: a brief note on why the presentation is OCD rather than GAD, a tic disorder, autism-related repetitive behavior, or body dysmorphic disorder.
Comorbidities: any co-occurring anxiety, depression, or tic diagnoses you are also coding, with the primary focus of treatment identified.
Frequently Asked Questions
- What is the ICD-10 code for OCD?
- The ICD-10-CM code for classic obsessive-compulsive disorder, where both obsessions and compulsions are present, is F42.2 (mixed obsessional thoughts and acts). F42 on its own is a non-billable category header and will be rejected. When you do not yet have enough detail to specify the presentation, use F42.9 (OCD, unspecified) as a temporary placeholder.
- What is the ICD-10 code for OCD with anxiety?
- There is no single combined code. Bill OCD (F42.2) and the specific anxiety disorder together, for example F42.2 plus F41.1 (generalized anxiety disorder) or F42.2 plus F40.10 (social anxiety disorder). List the primary focus of treatment first and document how each condition is being addressed.
- Is there a separate OCD code for children?
- No. OCD in children uses the same F42 codes as adults; there is no pediatric-specific OCD code. Classic pediatric OCD is F42.2. Document age of onset, symptom content, time spent on obsessions and compulsions, and functional impairment across settings such as home and school.
- What is the ICD-10 code for hoarding?
- Hoarding disorder is F42.3. It is its own billable diagnosis within the F42 family, not a subtype of OCD, and should be coded separately when hoarding is the primary presentation. Skin-picking (excoriation) disorder is F42.4.
- How do I code body dysmorphic disorder?
- Body dysmorphic disorder is F45.22, not an F42 code. This is a frequent miscode because BDD sits on the obsessive-compulsive spectrum clinically, but ICD-10-CM classifies it under somatoform disorders. Use F45.22 for BDD and reserve F42 codes for OCD, hoarding, and excoriation.
- When should I use F42.9 (unspecified) versus F42.2?
- Use F42.2 whenever your assessment supports classic OCD with obsessions and compulsions, which is most cases. Reserve F42.9 for genuinely incomplete evaluations, such as an initial visit before you have characterized the presentation. Payers scrutinize unspecified codes, so move to a specific code as soon as documentation supports it.
Accurate OCD coding starts with remembering that F42 needs a fourth character and that classic OCD is F42.2. Specify the presentation, code comorbidities separately, and keep hoarding, excoriation, and body dysmorphic disorder in their correct homes.