ICD-10-CM code F60.0 designates paranoid personality disorder (PPD), a Cluster A personality disorder characterized by a pervasive, enduring pattern of distrust and suspiciousness toward others whose motives are interpreted as malevolent — absent psychosis or a diagnosable thought disorder. The code is billable, valid for HIPAA-covered transactions from October 1, 2025 through September 30, 2026, and falls under Chapter 5 (Mental, Behavioral and Neurodevelopmental Disorders) of the ICD-10-CM Official Coding Guidelines published by CMS. Unlike psychotic-spectrum diagnoses, F60.0 requires documented non-psychotic personality pathology — a distinction that drives every documentation and billing decision covered in this guide.
What Does ICD-10 Code F60.0 Mean?
F60.0 — Paranoid Personality Disorder is a billable, diagnosis-specific ICD-10-CM code used to classify an enduring personality disturbance in which the individual harbors deep, pervasive suspicion of others without a basis in reality and without reaching the threshold of a fixed delusion or frank psychosis. The pattern must be stable across situations and settings, traceable to early adulthood, and must cause clinically significant impairment in social or occupational functioning.
Key attributes of this code at a glance:
- Valid for use: FY2026 (October 1, 2025 – September 30, 2026)
- Billable/specific: Yes — this is a terminal, reportable code
- Applicable settings: Outpatient, inpatient psychiatric, partial hospitalization, telehealth behavioral health
- Chapter classification: Chapter 5, F60–F69 (Disorders of Adult Personality and Behavior)
- ICD-9-CM crosswalk: 301.0 (Paranoid personality disorder) — direct one-to-one mapping
What Conditions and Diagnoses Does F60.0 Cover?
F60.0 covers a range of clinical presentations that reflect the core paranoid personality construct — deep, non-delusional suspicion and interpersonal hypersensitivity. The ICD-10-CM Tabular List specifies several inclusion terms under this code:
- Expansive paranoid personality disorder — grandiose self-importance intertwined with suspicion of others
- Fanatic personality disorder — rigid, zealous conviction that others are adversarial
- Querulant personality disorder — persistent litigious behavior driven by perceived injustice
- Sensitive paranoid personality disorder — hypersensitivity combined with self-referential thinking
- Paranoid personality disorder, NOS — when PPD is documented without a qualifying subtype
In practice, coders frequently encounter psychiatry and psychology notes where the provider uses phrases like “pervasive distrust,” “persistent suspiciousness,” or “hypersensitivity to perceived slights” without specifying a subtype. Any of these, when linked to a formal personality disorder diagnosis, map cleanly to F60.0.
What Does F60.0 Specifically Exclude?
F60.0 carries a Type 2 Excludes (Excludes2) notation, meaning the following codes are not included here but may be coded alongside F60.0 when both conditions are independently documented and meet criteria:
- F22 — Delusional disorder (paranoia, paranoia querulans, paranoid psychosis, paranoid state)
- F20.0 — Paranoid schizophrenia
- F22 (paranoid state) — Transient or reactive paranoid episodes not meeting personality disorder criteria
The Excludes2 designation is critical: it is not a prohibition on dual coding — it is a signal that these are distinct conditions that happen to share surface-level symptom overlap.
When Is F60.0 the Right Code to Use?
Correct application of F60.0 depends on a precise differential between non-psychotic personality pathology and psychotic-spectrum disorders. Use this numbered decision framework before assigning the code:
- Confirm the diagnosis is explicitly documented. F60.0 cannot be inferred from symptoms alone. A licensed clinician (psychiatrist, psychologist, or authorized provider) must document a formal diagnosis of paranoid personality disorder.
- Verify the pattern is enduring and pervasive. The suspiciousness must be stable across multiple contexts, not situational or episodic — distinguishing it from an acute paranoid reaction.
- Confirm the absence of psychosis. Fixed delusions or hallucinations shift the diagnosis toward F20.0 (paranoid schizophrenia) or F22 (delusional disorder). If the provider documents that paranoid ideation does not reach the level of delusion, F60.0 is appropriate.
- Rule out a general medical etiology. If the paranoid features result from a neurological condition, substance use, or another documented medical condition, a different code hierarchy may apply.
- Confirm the patient is an adult or that the behavior has persisted into adulthood. Per ICD-10-CM chapter guidance, specific personality disorder codes are not routinely applied before age 18 without clinical justification.
How Does F60.0 Differ From F22 (Delusional Disorder)?
This is the most common point of confusion in outpatient behavioral health coding. The distinction hinges on whether suspicious beliefs rise to the level of a fixed delusion or remain within the realm of personality trait.
| Feature | F60.0 — Paranoid Personality Disorder | F22 — Delusional Disorder |
|---|---|---|
| Nature of belief | Pervasive suspicion, not a fixed delusion | Fixed, circumscribed, non-bizarre delusion |
| Reality testing | Partially intact — patient may question their suspicion | Absent — patient holds belief as absolute fact |
| Psychosis present? | No | No (but delusion itself is present) |
| Insight | Some capacity for self-reflection | Typically none regarding the delusion |
| Duration | Lifelong personality trait | Often episodic or persistent but distinct onset |
| Onset | Emerges in adolescence/early adulthood | Can emerge at any adult age |
| Typical setting | Outpatient mental health | Psychiatric inpatient or outpatient |
Auditors commonly flag claims where F60.0 is billed but the clinical notes describe fixed, unshakeable beliefs — a documentation pattern that should trigger reconsideration toward F22.
What Documentation Is Required to Support F60.0?
Inadequate documentation is the primary driver of claim denials and audit findings for F60-range codes. Because paranoid personality disorder is diagnosed through behavioral observation and clinical judgment rather than laboratory testing, the note-level narrative carries the entire evidentiary burden.
What Must the Provider Document in the Clinical Notes?
The treating clinician’s notes must establish all of the following to support F60.0:
- Explicit diagnosis statement — The provider must write “paranoid personality disorder” or a documented equivalent; coders cannot infer this from symptom descriptions alone.
- Longitudinal pattern evidence — Documentation of when the pattern began (typically adolescence or early adulthood) and how it has persisted across time and settings.
- Functional impairment — Specific documentation of how the disorder affects occupational functioning, social relationships, or activities of daily living.
- Behavioral indicators — At least two or three specific documented behaviors: e.g., recurrent unfounded suspicion of infidelity, reluctance to confide due to fear of information being used against them, reading hidden threatening meaning into benign remarks.
- Absence of psychosis — A positive statement that suspiciousness does not reach the level of a fixed delusion and that no hallucinations are present.
- DSM-5 criterion alignment — Many payers require that the note demonstrate the clinician applied DSM-5 diagnostic criteria; a reference to criteria met (e.g., “meets ≥4 of 7 DSM-5 PPD criteria”) strengthens medical necessity documentation.
Which Diagnostic or Lab Results Support This Code?
F60.0 does not require laboratory confirmation, but standardized assessment instruments add significant documentary weight:
- Personality Assessment Inventory (PAI) — scales for paranoia and related constructs
- Minnesota Multiphasic Personality Inventory (MMPI-2 or MMPI-3) — paranoia (Pa) scale elevation
- Millon Clinical Multiaxial Inventory (MCMI-IV) — personality disorder pattern profiles
- Structured clinical interviews — SCID-5-PD (Structured Clinical Interview for DSM-5 Personality Disorders)
- Collateral history — Third-party accounts of the patient’s interpersonal patterns corroborating the diagnostic impression
What Is the Documentation Standard for Inpatient vs. Outpatient Settings?
| Documentation Element | Outpatient / Telehealth | Inpatient Psychiatric |
|---|---|---|
| Who can diagnose | Licensed psychiatrist, psychologist, or qualified mid-level in scope | Attending psychiatrist of record |
| Diagnosis statement required | Yes — in assessment/plan | Yes — on face sheet and discharge summary |
| Functional impairment | Must be noted | Must address how disorder contributed to admission |
| Psychosis exclusion statement | Strongly recommended | Required for clear distinction from F20.0/F22 |
| Code position (principal vs. secondary) | Can be principal or secondary | If reason for admission → principal; if contributing factor → secondary |
| Assessment tools | Recommended, not mandated | Recommended; often required by facility policy |
How Does F60.0 Affect Medical Billing and Claims?
F60.0 functions as a standalone billable diagnosis that supports a range of mental health services when paired with appropriate CPT procedure codes. Payer coverage for personality disorder treatment varies considerably, and revenue cycle teams must verify medical necessity at the plan level.
Key billing considerations:
- F60.0 can serve as the primary/principal diagnosis for outpatient psychiatric visits and individual psychotherapy sessions when PPD is the primary clinical focus.
- Many commercial payers and Medicare will require the note to demonstrate that treatment is targeting functional impairment — not simply documenting the diagnosis.
- Because PPD is a chronic condition, ongoing claims may trigger medical necessity review; treatment plans must reflect measurable goals tied to functional improvement.
- Mental health parity laws (under the Mental Health Parity and Addiction Equity Act) generally require behavioral health benefits to be covered on terms comparable to medical/surgical benefits — relevant when payers attempt to limit sessions.
What CPT or Procedure Codes Are Commonly Billed With F60.0?
| CPT Code | Description | Typical Pairing Context with F60.0 |
|---|---|---|
| 90837 | Psychotherapy, 60 minutes | Standard individual outpatient therapy for PPD |
| 90832 | Psychotherapy, 30 minutes | Brief follow-up sessions with established patients |
| 90847 | Family psychotherapy, with patient present, 60 min | When family dynamics are impacted by patient’s paranoid traits |
| 90853 | Group psychotherapy | Group settings for interpersonal skills work (challenging but valid) |
| 90791 | Psychiatric diagnostic evaluation | Initial evaluation establishing PPD diagnosis |
| 99213–99215 | Office or outpatient E&M | Psychiatrist managing medication alongside PPD (e.g., augmentation for comorbid anxiety) |
| 96130–96131 | Psychological testing evaluation | When PAI, MMPI, or MCMI is administered to support the diagnostic impression |
Are There Any Prior Authorization or Coverage Restrictions?
- Medicare covers outpatient mental health services under Part B; however, PPD does not have a specific LCD (Local Coverage Determination). Medical necessity is established note-by-note.
- Commercial payers frequently require prior authorization for psychotherapy beyond an initial session allotment; treatment plans citing F60.0 should document specific, measurable treatment goals.
- Medicaid coverage varies by state; some state Medicaid programs require a behavioral health assessment tool score to justify extended outpatient treatment.
- No specific National Coverage Determination (NCD) exists for paranoid personality disorder treatment, leaving coverage decisions at the MAC (Medicare Administrative Contractor) level.
What Coding Errors Should You Avoid With F60.0?
Personality disorder codes are among the most frequently misapplied in behavioral health billing. The following errors appear most often in pre-bill audits and post-payment reviews:
- Coding F60.0 from symptoms alone. If the provider documents “patient is paranoid and distrustful” without a formal PPD diagnosis, the code is not supported — F60.9 (unspecified personality disorder) would also be inaccurate without a diagnosis statement.
- Failing to distinguish F60.0 from F22. Assigning F60.0 when the clinical notes describe fixed, unshakeable beliefs the patient cannot question is incorrect; F22 (delusional disorder) applies instead.
- Using F60.9 when F60.0 is clearly documented. Defaulting to the unspecified code when the provider’s note states “paranoid personality disorder” wastes specificity, may reduce reimbursement, and creates audit exposure.
- Applying F60.0 to a pediatric patient without clinical justification. Per ICD-10-CM chapter-level guidance, specific personality disorder codes require careful clinical justification for patients under 18.
- Omitting F60.0 as a secondary code when it affects the clinical picture. In inpatient settings, a documented PPD diagnosis that influenced the patient’s behavior and treatment planning should be coded even when it is not the principal reason for admission.
What Do Auditors Look for When Reviewing Claims With F60.0?
- A clear, explicit diagnosis statement — not just symptom documentation
- Provider credentials — PPD must be diagnosed by a clinician operating within scope
- Consistency between the diagnosis and the treatment modality billed (e.g., individual psychotherapy vs. group vs. medication management)
- Evidence that psychosis was ruled out, particularly on claims where F60.0 and F20.x or F22 might both be considered
- Medical necessity language in progress notes tied to functional impairment — not just diagnosis maintenance
- Absence of duplicate billing when both a psychiatric evaluation (90791) and psychotherapy (90837) are billed on the same date without appropriate documentation of distinct services
How Does F60.0 Relate to Other ICD-10 Codes?
F60.0 sits within a web of closely related codes that reflect overlapping but clinically distinct presentations. Understanding the full code neighborhood is essential for accurate sequencing and differential coding.
| Related Code | Code Title | Relationship to F60.0 | Key Distinction |
|---|---|---|---|
| F60.9 | Personality disorder, unspecified | Same parent category — less specific | Use when provider documents personality disorder without specifying type |
| F22 | Delusional disorder | Excludes2 from F60.0 | Delusional disorder involves fixed delusions, not just suspicious personality traits |
| F20.0 | Paranoid schizophrenia | Excludes2 from F60.0 | Psychosis (hallucinations, disorganized thought) is present in F20.0 |
| F60.1 | Schizoid personality disorder | Same F60 category — Cluster A | Schizoid is marked by emotional detachment, not suspicion |
| Z87.39 | Personal history of other mental and behavioral disorders | History/status code | Used when PPD is in remission or historical |
| F41.1 | Generalized anxiety disorder | Commonly comorbid | Anxiety is frequently comorbid with PPD; can be coded additionally |
| F33.x | Major depressive disorder | Commonly comorbid | Depression often co-occurs; sequence by clinical hierarchy |
What Is the Correct Code Sequencing When F60.0 Appears With Other Diagnoses?
- When F60.0 is the primary reason for the encounter (e.g., outpatient psychotherapy focused on PPD): sequence F60.0 as the first-listed diagnosis.
- When a comorbid condition (e.g., F41.1, F33.x) is the primary reason for the visit: sequence the comorbid condition first, then F60.0 as an additional diagnosis.
- In inpatient settings: if PPD was the reason for admission, it is the principal diagnosis; if it is a contributing factor, it is a secondary code — per the Uniform Hospital Discharge Data Set (UHDDS) definition of principal diagnosis.
- When documenting both F60.0 and F22: only applicable when both conditions are independently established and documented by the provider; the Excludes2 notation permits dual coding in this circumstance.
Real-World Coding Scenario — How F60.0 Is Applied in Practice
Encounter summary: A 44-year-old male presents to an outpatient behavioral health clinic. His psychiatrist’s note documents: “Patient reports persistent belief that coworkers are conspiring to sabotage his performance reviews. He acknowledges he cannot prove this but maintains he is ‘certain of their motives.’ He has refused to attend team meetings for eight months due to this concern. No hallucinations reported. No evidence of fixed delusion — patient able to consider, briefly, alternative explanations. Longitudinal history of similar interpersonal suspicion since early 20s. Meets DSM-5 criteria for paranoid personality disorder (criteria A1, A2, A4, A5, A6 met). Diagnosis: Paranoid Personality Disorder. Session focused on cognitive restructuring of attribution style. 60-minute individual psychotherapy.”
Correct Code Application
- Primary diagnosis: F60.0 — Paranoid Personality Disorder
- CPT code billed: 90837 (Psychotherapy, 60 minutes)
- Rationale: Provider explicitly documents the PPD diagnosis, specifies DSM-5 criteria met, confirms absence of hallucinations, and documents intact (albeit limited) reality testing — distinguishing this from F22. The 60-minute therapy session maps directly to 90837.
Common Mistake in This Scenario
- Incorrect code: F22 (Delusional Disorder)
- Why it fails: The note explicitly states the patient “acknowledges he cannot prove this” and is “able to consider alternative explanations.” This documentation demonstrates partial reality testing — the hallmark of personality-level paranoia, not a fixed delusion. Assigning F22 would misrepresent the clinical picture, expose the claim to audit, and could affect the patient’s treatment trajectory and future coverage determinations.
Frequently Asked Questions About ICD-10 Code F60.0
Is ICD-10 Code F60.0 Valid for Use in 2026?
ICD-10-CM code F60.0 is valid and billable for fiscal year 2026, covering HIPAA-compliant transactions submitted from October 1, 2025 through September 30, 2026. No changes were made to the code’s description, inclusion terms, or validity status in the 2026 ICD-10-CM update cycle. Coders should verify status annually against the CMS ICD-10-CM release.
What Is the Difference Between F60.0 and F22?
F60.0 applies when paranoia is a non-psychotic personality trait — the patient is suspicious, mistrustful, and interprets others’ motives as malevolent, but can partially question those beliefs. F22 applies when the patient holds a fixed, unshakeable delusion, such as an absolute conviction of persecution, that cannot be reality-tested. The clinical notes must explicitly differentiate the nature and intensity of the paranoid ideation for the coder to select the correct code.
Can F60.0 Be Billed as a Secondary Diagnosis?
Yes, F60.0 can and should be reported as a secondary diagnosis when paranoid personality disorder is documented and clinically relevant to the encounter, even if another condition is the primary reason for the visit. In inpatient psychiatric settings, PPD documented as a contributing factor to the patient’s clinical picture must be captured as a secondary code per diagnosis code specificity requirements.
What Documentation Failure Most Often Causes F60.0 Claim Denials?
The most common documentation failure is coding F60.0 based on symptom descriptions rather than an explicit provider diagnosis statement. If the note reads “patient displays paranoid ideation” without a formal diagnostic conclusion, the code lacks clinical support. A second frequent issue is the absence of functional impairment language — payers require evidence that the disorder causes significant disruption to social, occupational, or daily functioning to establish medical necessity.
Can F60.0 Be Used for Patients Under 18?
The ICD-10-CM Official Coding Guidelines indicate that specific personality disorder diagnoses require clinical caution in patients under 18 due to ongoing personality development. Most authoritative clinical standards, including DSM-5-TR, recommend against diagnosing a personality disorder in a minor unless the pattern has been present for at least one year and is pervasive and stable. If a diagnosis is made and documented by a licensed clinician for a minor, the code is technically applicable, but the clinical record should include explicit justification.
What CPT Code Is Most Commonly Paired With F60.0?
CPT code 90837 (individual psychotherapy, 60 minutes) is the most commonly paired procedure code with F60.0 in outpatient behavioral health settings, as psychotherapy is the primary treatment modality for paranoid personality disorder. When the initial diagnostic evaluation establishes the PPD diagnosis, 90791 (psychiatric diagnostic evaluation) is appropriate for that encounter. If a psychiatrist manages comorbid pharmacotherapy, standard E&M codes (99213–99215) are billed for those medication management visits, with F60.0 listed as a supporting or additional diagnosis.
Key Takeaways
Every coder and billing professional working in behavioral health should keep the following principles in mind for F60.0:
- F60.0 is a billable, diagnosis-specific code for paranoid personality disorder — the provider must explicitly document the diagnosis, not just describe symptoms.
- The core distinction between F60.0 and F22 is the presence or absence of reality testing — partial insight points to F60.0; fixed, unshakeable delusion points to F22.
- Inclusion terms such as expansive paranoid personality, querulant personality, and fanatic personality disorder all map to F60.0.
- Documentation must establish an enduring, pervasive pattern, functional impairment, and the absence of psychosis to pass payer scrutiny.
- F60.0 pairs most commonly with CPT codes 90837, 90791, and 90847 in outpatient settings.
- The Excludes2 notation means F22 and F60.0 can coexist on a claim only when both conditions are independently documented and clinically distinct.
- Annual verification against the ICD-10-CM Official Coding Guidelines is essential — code validity and description changes are published each October.
For additional guidance on coding audit preparation and revenue cycle compliance in behavioral health, review the AHA Coding Clinic for the most current ICD-10-CM editorial guidance on mental and behavioral disorder coding.
Content is provided for educational purposes and does not constitute legal, clinical, or compliance advice. Always verify code validity and payer-specific requirements against current official sources before submitting claims.