R46.81 - Obsessive-compulsive behavior

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

• Addiction
• Biting self
• Compulsion expressed as ritual
• Compulsion to act on dangerous thoughts
• Compulsion to act on thoughts
• Compulsive arrangement of objects
• Compulsive behavior
• Compulsive buying
• Compulsive checking
• Compulsive cleaning
• Compulsive counting
• Compulsive drug taking
• Compulsive handwashing
• Compulsive hoarding
• Compulsive purposeless behavior
• Compulsive repeating
• Compulsive scratching behavior
• Compulsive self-biting behavior
• Compulsive tidying
• Compulsive touching
• Compulsive uncontrollable drug taking
• Compulsive washing
• Compulsive water drinking
• Excessive exercise
• Finding related to ability to resist dangerous thoughts
• Finding related to ability to resist obsessional thoughts
• Hoarding
• Inability to resist compulsive behaviors
• Obsessive behavior
• Psychological addiction
• Scratches self
• Unable to resist dangerous thoughts
• Unable to resist obsessional thoughts

Clinical Information

• Compulsive Behavior-. the behavior of performing an act persistently and repetitively without it leading to reward or pleasure. the act is usually a small, circumscribed behavior, almost ritualistic, yet not pathologically disturbing. examples of compulsive behavior include twirling of hair, checking something constantly, not wanting pennies in change, straightening tilted pictures, etc.
• Hoarding-. a persistent difficulty discarding or parting with possessions.
• Hoarding Disorder-. disordered behavior associated with clinically significant distress or impairment in social, occupational or other important areas of functioning and persistent difficulty parting with possessions due to a perceived need to save the items and distress associated with discarding them. (from dsm-v) the quantity of collected items sets the behavior apart from normal collecting behaviors.
• Obsessive Behavior-. persistent, unwanted idea or impulse which is considered normal when it does not markedly interfere with mental processes or emotional adjustment.

Code Edits

The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10 Code Edits are applicable to this code:

• Unacceptable principal diagnosis - There are selected codes that describe a circumstance which influences an individual's health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.

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Patient Education

Obsessive-Compulsive Disorder

What is obsessive-compulsive disorder (OCD)?

Obsessive-compulsive disorder (OCD) is a mental disorder in which you have thoughts (obsessions) and rituals (compulsions) over and over. They interfere with your life, but you cannot control or stop them.

What causes obsessive-compulsive disorder (OCD)?

The cause of obsessive-compulsive disorder (OCD) is unknown. Factors such as genetics, brain biology and chemistry, and your environment may play a role.

Who is at risk for obsessive-compulsive disorder (OCD)?

Obsessive-compulsive disorder (OCD) usually begins when you are a teen or young adult. Boys often develop OCD at a younger age than girls.

Risk factors for OCD include:

• Family history. People with a first-degree relative (such as a parent, sibling, or child) who has OCD are at higher risk. This is especially true if the relative developed OCD as a child or teen.
• Brain structure and functioning. Imaging studies have shown that people with OCD have differences in certain parts of the brain. Researchers need to do more studies to understand the connection between the brain differences and OCD.
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• Childhood trauma, such as child abuse. Some studies have found a link between trauma in childhood and OCD. More research is needed to understand this relationship better.

In some cases, children may develop OCD or OCD symptoms following a streptococcal infection. This is called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).

What are the symptoms of obsessive-compulsive disorder (OCD)?

People with OCD may have symptoms of obsessions, compulsions, or both:

• Obsessions are repeated thoughts, urges, or mental images that cause anxiety. They may involve things such as
  • Fear of germs or contamination
  • Fear of losing or misplacing something
  • Worries about harm coming towards yourself or others
  • Unwanted forbidden thoughts involving sex or religion
  • Aggressive thoughts towards yourself or others
  • Needing things lined up exactly or arranged in a particular, precise way
• Compulsions are behaviors that you feel like you need to do over and over to try to reduce your anxiety or stop the obsessive thoughts. Some common compulsions include
  • Excessive cleaning and/or handwashing
  • Repeatedly checking on things, such as whether the door is locked or the oven is off
  • Compulsive counting
  • Ordering and arranging things in a particular, precise way

Some people with OCD also have a Tourette syndrome or another tic disorder. Tics are sudden twitches, movements, or sounds that people do repeatedly. People who have tics cannot stop their body from doing these things.

How is obsessive-compulsive disorder (OCD) diagnosed?

The first step is to talk with your health care provider about your symptoms. Your provider should do an exam and ask you about your medical history. He or she needs to make sure that a physical problem is not causing your symptoms. If it seems to be a mental problem, your provider may refer you to a mental health specialist for further evaluation or treatment.

Obsessive-compulsive disorder (OCD) can sometimes be hard to diagnose. Its symptoms are like those of other mental disorders, such as anxiety disorders. It is also possible to have both OCD and another mental disorder.

Not everyone who has obsessions or compulsions has OCD. Your symptoms would usually be considered OCD when you:

• Can't control your thoughts or behaviors, even when you know that they are excessive
• Spend at least 1 hour a day on these thoughts or behaviors
• Don't get pleasure when performing the behaviors. But doing them may briefly give you relief from the anxiety that your thoughts cause.
• Have significant problems in your daily life because of these thoughts or behaviors

What are the treatments for obsessive-compulsive disorder (OCD)?

The main treatments for obsessive-compulsive disorder (OCD) are cognitive behavioral therapy, medicines, or both:

• Cognitive behavioral therapy (CBT) is a type of psychotherapy. It teaches you different ways of thinking, behaving, and reacting to the obsessions and compulsions. One specific type of CBT that can treat OCD is called Exposure and Response Prevention (EX/RP). EX/RP involves gradually exposing you to your fears or obsessions. You learn healthy ways to deal with the anxiety they cause.
• Medicines for OCD include certain types of antidepressants. If those don't work for you, your provider may suggest taking some other type of psychiatric medicine.

NIH: National Institute of Mental Health

Code History

• FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
• FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
• FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
• FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
• FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
• FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
• FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
• FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016 (First year ICD-10-CM implemented into the HIPAA code set)