Oppositional Defiant Disorder ICD-10 Code: F91.3 Coding and Billing Guide

The ICD-10-CM code for oppositional defiant disorder (ODD) is F91.3. It is a complete, billable code, so you can report it on a claim as it stands, with no extra characters needed.

That's the quick answer. The longer one is what decides whether the claim gets paid. ODD sits right next to conduct disorder, disruptive mood dysregulation disorder (DMDD) and ADHD, and each of those has its own code and its own coding rules. Pick the wrong neighbor and you end up with a denial, a records request, or a diagnosis that doesn't match the treatment notes.

This guide covers what F91.3 means, how the DSM-5-TR criteria translate into a coded diagnosis, how to tell ODD apart from similar conditions, and what your documentation needs to say before you submit.

Quick Answer: ODD ICD-10 Code at a Glance

• ICD-10-CM code: F91.3, Oppositional defiant disorder
• Billable: Yes, it is a specific, reportable code
• Category: F91, Conduct disorders, within F90 to F98 (behavioral and emotional disorders with onset usually in childhood and adolescence)
• DSM-5-TR code: F91.3 (the same code)
• ICD-11 code: 6C90 (ICD-11 is not used for U.S. claims)
• Code set year: Valid for FY 2026 and carried into the FY 2027 code set that takes effect on October 1, 2026

What Is Oppositional Defiant Disorder?

Oppositional defiant disorder is a behavioral condition marked by a lasting pattern of angry or irritable mood, argumentative or defiant behavior, and vindictiveness. It usually shows up in the preschool years and rarely starts later than early adolescence. Commonly cited prevalence estimates run from about 2% to 16% of children, depending on the study and the age group, and it is diagnosed more often in boys before adolescence.

Every child argues, refuses, and slams a door now and then. What separates ODD from ordinary testing of limits is how long it lasts, how often it happens, and how much it disrupts home, school, or friendships. That difference is exactly what your documentation has to show, and we'll come back to it.

ICD-10-CM Code F91.3: What It Includes

F91.3 lives in Chapter 5 of ICD-10-CM, Mental, Behavioral and Neurodevelopmental Disorders. Inside that chapter, it belongs to the F91 conduct disorders family. The index also points several everyday phrases to the same code, including "oppositional defiance," "defiant oppositional," and "oppositional disorder."

One point that surprises many billers: the F90 to F98 block has a note saying these codes may be used regardless of the patient's age. These disorders usually begin in childhood, but they can continue into adulthood. An adult with a well-documented ODD diagnosis can still be coded F91.3.

The F91 Code Family

F91.9 is the usual fallback when the record says "behavioral problems" or "conduct disorder" without enough detail. If the clinician has actually diagnosed ODD, F91.9 undersells the diagnosis and can weaken medical necessity.

From DSM-5-TR Criteria to a Coded Diagnosis

The clinician diagnoses. The coder translates. So it helps to know what the clinician is looking for, because your notes need to reflect it.

DSM-5-TR describes eight symptoms in three groups:

• Angry or irritable mood: often loses temper, is often touchy or easily annoyed, is often angry and resentful
• Argumentative or defiant behavior: argues with authority figures (or with adults, in children and adolescents), actively defies or refuses to follow rules or requests, deliberately annoys others, blames others for mistakes
• Vindictiveness: has been spiteful or vindictive at least twice in the past six months

At least four symptoms must be present, and the pattern must last at least six months, with at least one person who is not a sibling. For children under five, the behavior should occur on most days. For patients five and older, it should occur at least once a week. The behavior also has to cause real distress or impairment in social, academic, or occupational functioning.

DSM-5-TR adds a severity specifier:

• Mild: symptoms appear in one setting only
• Moderate: symptoms appear in at least two settings
• Severe: symptoms appear in three or more settings

The severity specifier is clinically useful, but it does not change the ICD-10-CM code. It is F91.3 either way. Still, a note that says "moderate, symptoms at home and school" tells the payer far more than "ODD" alone.

ODD vs. DMDD vs. Conduct Disorder vs. ADHD

This is where most coding errors start, so it deserves a careful look.

ODD and DMDD (F34.81)

Disruptive mood dysregulation disorder is coded F34.81 and sits in the mood disorders chapter, not with the conduct disorders. The two overlap in symptoms, since both involve irritability and outbursts. DSM-5-TR treats them as mutually exclusive: if a child meets criteria for both, the diagnosis is DMDD, not ODD. So F91.3 and F34.81 shouldn't appear together on the same claim for the same period.

ODD and conduct disorder (F91.1, F91.2)

Conduct disorder involves more serious behavior, such as aggression toward people or animals, property destruction, deceitfulness, theft, or serious rule violations. When a clinician documents conduct disorder, the record should explain how the picture changed from ODD, particularly if an earlier F91.3 diagnosis is already in the chart. Payers notice when a diagnosis shifts with no clinical story behind it. Before reporting both codes on one claim, check the clinician's documentation and the payer's policy.

ODD and ADHD (F90.x)

These two often travel together. When both are diagnosed and documented, ADHD is reported with its own F90 code alongside F91.3. Each diagnosis should be supported by its own assessment and treatment notes, so the claim doesn't look like one diagnosis was tacked on.

ODD and symptom codes

If the clinician hasn't confirmed a diagnosis yet, don't report one. Outpatient coding guidelines say not to code "probable," "suspected," or "rule out" conditions. Use the documented symptoms instead, such as R45.4 (irritability and anger) or R45.86 (emotional lability), until the diagnosis is confirmed.

Documentation That Supports F91.3

A clean claim starts with a clean note. For ODD, the record should show:

• A clear diagnostic statement by a qualified clinician, using the words "oppositional defiant disorder" and not just "behavior problems."
• Symptoms and duration, including which of the eight symptoms are present and that they've lasted at least six months.
• Settings and severity, meaning where the behavior occurs (home, school, community) and the mild, moderate, or severe specifier.
• Functional impairment, such as suspensions, family conflict, or trouble with peers. This is the backbone of medical necessity.
• Differential reasoning, showing that DMDD, conduct disorder, ADHD, anxiety, depression, and trauma-related conditions were considered.
• Assessment tools used, like rating scales or structured interviews, with dates and results.
• A treatment plan tied to the diagnosis, with measurable goals and a review schedule.

If any of these are missing, the claim may still be paid at first and clawed back later. Good behavioral health coding is really a discipline of keeping the note, the code, and the service line telling the same story. Our medical coding services team reviews notes for this kind of gap before claims go out.

Common Coding and Billing Mistakes With F91.3

• Using F91.9 when ODD is documented. It's vague, and vague codes invite questions.
• Reporting F91.3 and F34.81 together. DSM-5-TR treats them as mutually exclusive.
• Coding from a problem list. An old diagnosis carried forward, with no current assessment behind it, won't support the visit.
• Skipping the ADHD code when it's clearly documented. The full clinical picture affects medical necessity and care coordination.
• Assuming the code is only for kids. The age note in the F90 to F98 block means adults can be coded too, but the note has to justify it.
• Ignoring the October update. ICD-10-CM changes every October 1. After each update, check your EHR's diagnosis picklists and superbills so no one is choosing from a stale list.

When these errors turn into rejections, a structured denial management process helps you find the root cause instead of resubmitting the same claim. Our guide on how to prevent claim denials walks through the front-end habits that keep many of them from happening at all.

CPT Codes Commonly Billed With an ODD Diagnosis

F91.3 says why the patient is being seen. The CPT code says what you did. These are the services most often paired with an ODD diagnosis:

Family sessions matter a great deal in ODD care, since parent training and family work are central to treatment. That makes 90846 and 90847 common, and payers often look closely at them, so the note should say who attended and how the session related to the child's treatment goals. Practices that handle mental health billing know that timing, session length, and the participants recorded in the note all have to line up with the code.

Psychologists who bill testing services can find more on psychology billing, and therapists working in private practice may find the counseling and therapy billing page useful for their own setup. Pediatric offices that screen and refer for behavioral concerns face their own set of rules, covered under pediatrics billing.

Insurance, Authorization, and Enrollment Checks

A correct code still won't get paid if the front end is wrong. Before the first ODD visit:

• Run a benefits verification to confirm behavioral health coverage, visit limits, copays, and whether family therapy is covered.
• Check whether the plan needs prior authorization for psychological testing or higher levels of care.
• Make sure the treating clinician is enrolled with the payer. Even a perfect claim will be denied if the provider isn't in network, which is why mental health credentialing belongs on the same checklist as coding.
• For virtual visits, confirm each payer's telehealth rules on place of service and modifiers, since these vary. Our page on telemedicine billing covers the common ones.

ICD-10-CM vs. DSM-5-TR vs. ICD-11

People searching for the ODD code often mix up three systems, so here is how they fit together:

• DSM-5-TR is the clinical manual. It gives the diagnostic criteria and lists F91.3 as the code for ODD.
• ICD-10-CM is the U.S. code set required on claims. F91.3 is what you report.
• ICD-11 is the WHO's newer classification, which uses code 6C90 for ODD and adds specifiers for chronic irritability and prosocial emotions. It is not used for billing in the United States.

So the code stays the same whether you learned it from the DSM or the coding book. The DSM tells you how the diagnosis is made, and ICD-10-CM tells you how it's reported.

Frequently Asked Questions

Final Thoughts

F91.3 is simple to look up and easy to get wrong. The code itself takes a second. What takes care is the documentation behind it: the criteria, the duration, the settings, the impairment, and the reasoning that separates ODD from DMDD, conduct disorder, and ADHD. Get those right and the claim tells one consistent story from intake to payment.

If your practice wants fewer behavioral health denials and cleaner claims, our team handles the coding, billing, and follow-up so your clinicians can focus on patients. You can read more about our medical billing services or reach out directly below.

Written by

ClainetRCM Billing Team

ClainetRCM is a Boston-based revenue cycle management company specializing in medical billing, coding, and denial management for healthcare providers across all 50 states. Our AAPC and AHIMA certified coders track every ICD-10-CM update so claims go out coded to the current fiscal year's release.