What is ICD-10 code F42.2?

F42.2 is the ICD-10-CM code for Mixed Obsessional Thoughts and Acts, the most common OCD presentation in which both obsessions (intrusive thoughts) and compulsions (ritualistic behaviors) are present. The full F42 family includes F42.2 (mixed), F42.3 (hoarding), F42.4 (excoriation), F42.8 (other), and F42.9 (unspecified).

What are the diagnostic criteria for F42.2?

DSM-5-TR Obsessive-Compulsive Disorder requires: (A) presence of obsessions, compulsions, or both (obsessions are recurrent intrusive thoughts/images causing anxiety; compulsions are repetitive behaviors aimed at reducing anxiety); (B) symptoms are time-consuming (>1 hour/day) or cause clinically significant distress/impairment; (C) not attributable to a substance or medical condition; (D) not better explained by another mental disorder.

What scale is used to screen for F42.2?

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is the criterion-standard severity measure for OCD. The 10-item clinician-administered version produces a total score 0–40 across two subscales (obsessions 0–20, compulsions 0–20). Total scores: 0–7 subclinical, 8–15 mild, 16–23 moderate, 24–31 severe, 32–40 extreme.

What is the difference between F42.2 and F42.3 (hoarding)?

F42.2 is the OCD presentation with mixed obsessions and compulsions across themes (contamination, harm, symmetry, etc.). F42.3 is Hoarding Disorder, which DSM-5-TR separated from OCD in 2013, it requires persistent difficulty discarding possessions independent of value, with accumulation that congests living areas. The two are coded separately when both criteria are met.

Is OCD an anxiety disorder?

DSM-5-TR (2013) reclassified OCD into its own chapter, 'Obsessive-Compulsive and Related Disorders' (F42.x), separating it from the anxiety disorders. This reflects research showing distinct neurobiological substrates and treatment response patterns. Functionally, OCD shares anxious presentations with anxiety disorders but is now categorically distinct in DSM-5-TR and ICD-11.

Is F42.2 a billable ICD-10-CM code?

Yes, F42.2 is a billable code in the FY2027 ICD-10-CM code set (effective October 1, 2026). It is the most commonly reimbursed code for OCD when both obsessions and compulsions are present. Other billable F42 codes include F42.3 (Hoarding disorder), F42.4 (Excoriation/skin-picking disorder), F42.8 (Other obsessive-compulsive disorder), and F42.9 (unspecified).

What are the symptoms of obsessive-compulsive disorder?

Obsessive-compulsive disorder produces recurrent intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) aimed at reducing the resulting anxiety. Common obsession themes include contamination fears, harm or aggressive thoughts, symmetry or order, taboo sexual or religious thoughts, and pathological doubt. Common compulsions include excessive washing, checking, counting, mental rituals, and reassurance seeking. Symptoms must consume more than one hour per day or cause clinically significant distress or impairment.

How is OCD diagnosed?

OCD is diagnosed by a clinician using DSM-5-TR criteria, which require obsessions, compulsions, or both that consume more than one hour per day or cause clinically significant distress or impairment. Diagnosis typically follows a positive Y-BOCS severity rating (8 or higher indicates clinical OCD), structured clinical interview, ruling out other DSM-5-TR conditions that better explain the presentation, and screening for tic disorders and comorbid depression.

Obsessive-compulsive disorder arises from a combination of genetic, neurobiological, and environmental factors. Heritability estimates from twin studies range from 40% to 65%, with stronger genetic loading in early-onset OCD. Neurobiological contributors include cortico-striato-thalamo-cortical circuit hyperactivity, altered serotonin and glutamate signaling, and (in some cases) post-streptococcal autoimmune processes (PANDAS/PANS). Environmental triggers include trauma, stressful life events, and infection-linked onsets in pediatric cases.

OCD is a chronic condition that is highly treatable with combined therapy and medication. Exposure and response prevention (ERP), a form of cognitive behavioural therapy, is the first-line treatment with response rates of 60% to 80% across well-designed trials. SSRIs at higher doses than used for depression are first-line medication; clomipramine is a second-line option. Many patients achieve substantial remission, though some level of ongoing management is typical for long-term symptom control.

OCD stands for Obsessive-Compulsive Disorder, a condition characterized by recurrent intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). ICD-10-CM codes the most common presentation as F42.2 (mixed obsessional thoughts and acts). The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is the standard severity measure, and exposure and response prevention (ERP) plus SSRIs are the first-line evidence-based treatments.

F42.2ICD-10-CMObsessive-Compulsive Disorder (Mixed Obsessional Thoughts and Acts)

Official ICD-10-CM descriptor: Mixed obsessional thoughts and acts · Category header, not billable: use a more specific code

Recurrent intrusive thoughts (obsessions) and repetitive behaviors (compulsions) that consume more than one hour per day or cause clinically significant distress or impairment.

F42.2 at a glance

ICD-10-CM F42.2
OCD-Related
Category header, not billable: use a more specific code
Recommended screener
Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
View scale
Billing the screening
In the US, administering and scoring the scale usually bills under CPT 96127; the session itself under 90791 or 90834/90837. Coverage varies by payer.

DSM-5-TR diagnostic criteria summary

OCD requires:

Presence of obsessions, compulsions, or both:
- Obsessions, recurrent and persistent thoughts, urges, or images experienced as intrusive and unwanted, causing marked anxiety or distress; the person attempts to ignore or suppress them or neutralize them with another thought or action.
- Compulsions, repetitive behaviors (e.g., washing, checking, ordering) or mental acts (e.g., praying, counting, repeating words) the person feels driven to perform in response to an obsession; aimed at preventing distress or a feared event but not realistically connected.
Time-consuming (more than 1 hour per day) or causing clinically significant distress or impairment.
Not attributable to a substance or another medical condition.
Not better explained by another mental disorder (excessive worry in GAD; preoccupation with appearance in body dysmorphic disorder; ritualized eating in eating disorders; etc.).

Specifiers: insight (good/fair, poor, absent/delusional), tic-related.

Source: American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), p. 263–270.

Differential diagnosis

F42.3 Hoarding Disorder, persistent difficulty discarding possessions independent of value; separated from OCD in DSM-5-TR.
F45.22 Body Dysmorphic Disorder, preoccupation with perceived physical defect; repetitive behaviors are appearance-focused.
F50.x Eating Disorders, ritualized food restriction, eating, or compensatory behaviors; differential rests on whether thoughts are food/weight-focused (eating disorder) vs other content (OCD).
F41.1 Generalized Anxiety Disorder, excessive worry about real-life concerns; OCD obsessions are more intrusive, ego-dystonic, and triggered by specific stimuli.
F60.5 Obsessive-Compulsive Personality Disorder, pervasive pattern of preoccupation with order, perfectionism, and control; ego-syntonic vs OCD's ego-dystonic obsessions.
F84.0 Autism Spectrum Disorder, restricted repetitive behaviors are ego-syntonic and developmentally rooted, vs OCD's ego-dystonic anxiety-driven compulsions.

Common comorbidities

OCD has very high lifetime comorbidity. Common co-occurring conditions: Major Depressive Disorder (F33, F32, up to 60% lifetime), Anxiety Disorders (F40.x, F41.x), Tic Disorders (F95.x, particularly in early-onset OCD), Body Dysmorphic Disorder (F45.22), and Hoarding Disorder (F42.3). Co-administer PHQ-9 and GAD-7 alongside the Y-BOCS.

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Frequently asked questions

What is ICD-10 code F42.2?
F42.2 is the ICD-10-CM code for Mixed Obsessional Thoughts and Acts, the most common OCD presentation in which both obsessions (intrusive thoughts) and compulsions (ritualistic behaviors) are present. The full F42 family includes F42.2 (mixed), F42.3 (hoarding), F42.4 (excoriation), F42.8 (other), and F42.9 (unspecified).
What are the diagnostic criteria for F42.2?
DSM-5-TR Obsessive-Compulsive Disorder requires: (A) presence of obsessions, compulsions, or both (obsessions are recurrent intrusive thoughts/images causing anxiety; compulsions are repetitive behaviors aimed at reducing anxiety); (B) symptoms are time-consuming (>1 hour/day) or cause clinically significant distress/impairment; (C) not attributable to a substance or medical condition; (D) not better explained by another mental disorder.
What scale is used to screen for F42.2?
The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is the criterion-standard severity measure for OCD. The 10-item clinician-administered version produces a total score 0–40 across two subscales (obsessions 0–20, compulsions 0–20). Total scores: 0–7 subclinical, 8–15 mild, 16–23 moderate, 24–31 severe, 32–40 extreme.
What is the difference between F42.2 and F42.3 (hoarding)?
F42.2 is the OCD presentation with mixed obsessions and compulsions across themes (contamination, harm, symmetry, etc.). F42.3 is Hoarding Disorder, which DSM-5-TR separated from OCD in 2013, it requires persistent difficulty discarding possessions independent of value, with accumulation that congests living areas. The two are coded separately when both criteria are met.
Is OCD an anxiety disorder?
DSM-5-TR (2013) reclassified OCD into its own chapter, 'Obsessive-Compulsive and Related Disorders' (F42.x), separating it from the anxiety disorders. This reflects research showing distinct neurobiological substrates and treatment response patterns. Functionally, OCD shares anxious presentations with anxiety disorders but is now categorically distinct in DSM-5-TR and ICD-11.
Is F42.2 a billable ICD-10-CM code?
Yes, F42.2 is a billable code in the FY2027 ICD-10-CM code set (effective October 1, 2026). It is the most commonly reimbursed code for OCD when both obsessions and compulsions are present. Other billable F42 codes include F42.3 (Hoarding disorder), F42.4 (Excoriation/skin-picking disorder), F42.8 (Other obsessive-compulsive disorder), and F42.9 (unspecified).
What are the symptoms of obsessive-compulsive disorder?
Obsessive-compulsive disorder produces recurrent intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) aimed at reducing the resulting anxiety. Common obsession themes include contamination fears, harm or aggressive thoughts, symmetry or order, taboo sexual or religious thoughts, and pathological doubt. Common compulsions include excessive washing, checking, counting, mental rituals, and reassurance seeking. Symptoms must consume more than one hour per day or cause clinically significant distress or impairment.
How is OCD diagnosed?
OCD is diagnosed by a clinician using DSM-5-TR criteria, which require obsessions, compulsions, or both that consume more than one hour per day or cause clinically significant distress or impairment. Diagnosis typically follows a positive Y-BOCS severity rating (8 or higher indicates clinical OCD), structured clinical interview, ruling out other DSM-5-TR conditions that better explain the presentation, and screening for tic disorders and comorbid depression.
What causes OCD?
Obsessive-compulsive disorder arises from a combination of genetic, neurobiological, and environmental factors. Heritability estimates from twin studies range from 40% to 65%, with stronger genetic loading in early-onset OCD. Neurobiological contributors include cortico-striato-thalamo-cortical circuit hyperactivity, altered serotonin and glutamate signaling, and (in some cases) post-streptococcal autoimmune processes (PANDAS/PANS). Environmental triggers include trauma, stressful life events, and infection-linked onsets in pediatric cases.
Can OCD be cured?
OCD is a chronic condition that is highly treatable with combined therapy and medication. Exposure and response prevention (ERP), a form of cognitive behavioural therapy, is the first-line treatment with response rates of 60% to 80% across well-designed trials. SSRIs at higher doses than used for depression are first-line medication; clomipramine is a second-line option. Many patients achieve substantial remission, though some level of ongoing management is typical for long-term symptom control.
What is OCD?
OCD stands for Obsessive-Compulsive Disorder, a condition characterized by recurrent intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). ICD-10-CM codes the most common presentation as F42.2 (mixed obsessional thoughts and acts). The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is the standard severity measure, and exposure and response prevention (ERP) plus SSRIs are the first-line evidence-based treatments.

Sources

1. 1.American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), F42.2, p. 263–270.
2. 2.Goodman, W. K., et al. (1989). The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry, 46(11), 1006–1011.
3. 3.Centers for Disease Control and Prevention. ICD-10-CM Official Coding Guidelines.