ICD Code for Psychogenic Pseudosyncope
Psychogenic pseudosyncope should be coded as F44.89 (Other dissociative and conversion disorders) in ICD-10-CM, as it is classified psychiatrically as a conversion disorder—an involuntary somatic manifestation of internal psychological stresses. 1, 2
Understanding the Diagnostic Classification
Psychogenic pseudosyncope (PPS) represents the appearance of transient loss of consciousness without actual loss of consciousness, and is fundamentally a psychiatric condition rather than a cardiovascular or neurological one. 2, 3
Key Classification Points:
- PPS is a conversion disorder, not a true syncope, which distinguishes it from cardiovascular syncope codes (R55) 1, 2
- The condition involves involuntary episodes where patients appear unconscious but maintain normal cerebral perfusion, blood pressure, heart rate, and EEG activity 3, 4
- This is distinct from malingering or Munchausen syndrome, as PPS involves unconscious psychological mechanisms rather than deliberate fabrication 1
Alternative Coding Considerations:
While F44.89 is the most appropriate primary code, clinicians should be aware of related codes:
- F44.5 (Conversion disorder with seizures or convulsions) may be considered if the presentation mimics seizure-like activity, though PPS typically lacks the movements seen in psychogenic non-epileptic seizures (PNES) 5
- R55 (Syncope and collapse) should NOT be used as the primary code, as this implies true syncope with hemodynamic compromise, which is absent in PPS 3, 4
Clinical Documentation Requirements:
To support the F44.89 diagnosis code, documentation should include:
- Confirmation via tilt-table testing showing normal hemodynamic parameters (BP, HR) and EEG during apparent loss of consciousness 2, 6, 3
- Characteristic clinical features: prolonged apparent TLOC (median 44 seconds vs 20 seconds in true syncope), eyes closed during episodes (97% in PPS vs 7% in vasovagal syncope), and increased rather than decreased blood pressure and heart rate during events 4
- Absence of organic causes after appropriate cardiovascular and neurological evaluation 1
Important Coding Pitfall:
Do not assume all unexplained syncope in psychiatric patients is PPS—the European Heart Journal emphasizes excluding organic causes first, as misdiagnosis can lead to dangerous delays in treating true cardiac syncope. 1 The diagnosis requires objective confirmation, not just clinical suspicion. 3, 4