F42.2 — OCD, Mixed Obsessional Thoughts and Acts

Clinical Description

F42.2 codes obsessive-compulsive disorder where both obsessional thoughts and compulsive acts are prominent features. Documentation should capture the specific obsessions and compulsions, their frequency, and the degree of distress and functional impairment they cause.

Key Symptoms to Document

When using F42.2, your documentation should reference these symptoms:

• Recurrent, intrusive obsessional thoughts (e.g., contamination, harm, symmetry)
• Repetitive compulsive behaviors or mental acts (e.g., checking, washing, counting)
• Recognition that the obsessions/compulsions are excessive (may be limited in severe cases)
• Significant time consumed by obsessions and compulsions (typically >1 hour/day)
• Marked distress or anxiety when unable to perform rituals
• Avoidance of situations that trigger obsessions

Common Interventions to Document

Evidence-based interventions typically documented with this diagnosis:

• Exposure and Response Prevention (ERP)
• SSRI pharmacotherapy at higher doses (e.g., fluoxetine 40-80mg, fluvoxamine)
• Cognitive Behavioral Therapy (CBT) with cognitive restructuring
• Augmentation with low-dose antipsychotic if SSRI-refractory
• Acceptance and Commitment Therapy (ACT) as adjunct

CPT Code Pairings

Common CPT codes used when billing with F42.2:

• 90791 — Psychiatric diagnostic evaluation
• 90837 — Individual psychotherapy, 60 minutes
• 90834 — Individual psychotherapy, 45 minutes
• 96127 — Brief emotional/behavioral assessment (e.g., Y-BOCS)
• 99214 — Office visit, moderate complexity (medication management)

Documentation Tips

• Document the specific content of obsessions (contamination, harm, symmetry, taboo thoughts) and their corresponding compulsions.
• Record the amount of time per day spent on obsessions/compulsions and the degree of resistance and control.
• Use Y-BOCS scores to establish baseline severity and track treatment response.
• Note the patient's level of insight — good, fair, poor, or absent — as this affects treatment approach.
• Document functional impairment across domains (work productivity, relationships, self-care).

Differential Diagnosis Considerations

When documenting F42.2, consider and rule out:

• Generalized anxiety disorder (F41.1)
• Body dysmorphic disorder (F45.22)
• Hoarding disorder (F42.3)
• Illness anxiety disorder (F45.21)
• Obsessive-compulsive personality disorder (F60.5)
• Tic disorders (F95.x)

Screening Tools

Standardized measures commonly used with this diagnosis:

• Y-BOCS (Yale-Brown Obsessive Compulsive Scale)
• OCI-R (Obsessive-Compulsive Inventory — Revised)
• DOCS (Dimensional Obsessive-Compulsive Scale)
• Florida Obsessive-Compulsive Inventory (FOCI)