What diagnosis code can be used for a patient with a history of argumentative behavior, factitious disorder, and dishonesty, who is consistently demanding, rude, and ungrateful despite accommodations, and has been caught lying about appointment details?

Documentation Strategy for Challenging Patient-Provider Relationships

Document this encounter using objective behavioral observations without psychiatric diagnosis codes, focusing on specific factual statements and actions that demonstrate the therapeutic relationship has become non-productive, which justifies practice discharge for incompatibility rather than attempting to assign a psychiatric diagnosis code.

Why Diagnosis Codes Are Not Appropriate Here

The situation you describe does not warrant a psychiatric diagnosis code for several critical reasons:

• Factitious disorder requires specific diagnostic criteria that include intentional production of physical or psychological symptoms to assume the sick role, not simply being demanding or dishonest about administrative details 1, 2
• The American Academy of Pediatrics clarifies that factitious disorder symptoms must be intentionally produced medical symptoms, and must be distinguished from malingering (which involves material gain) 1
• Lying about appointment duration is not a psychiatric symptom—it's a behavioral issue that reflects relationship dysfunction, not a diagnosable mental disorder 1
• Personality disorders like Paranoid Personality Disorder require pervasive patterns across multiple contexts with specific diagnostic criteria, not isolated difficult interactions in a medical setting 3

How to Document Objectively

Use factual, behavioral language without psychiatric labeling:

• Document specific observable behaviors with dates and quotes: "Patient stated on [date] that she was told appointment would be 60 minutes. Office records confirm no such communication occurred and practice does not offer 60-minute appointments" 1
• Record specific examples of demands: "Patient requested [specific accommodation] on [date]. Provider complied. Patient subsequently expressed dissatisfaction stating [exact quote]" 1
• Note patterns without interpretation: "Patient has questioned or rejected the following treatment recommendations: [list with dates]" 1
• Document your clinical concerns objectively: "Provider has concerns that continuing care may not be in patient's best interest given repeated pattern of dissatisfaction despite multiple accommodations" 1

Critical Documentation Pitfalls to Avoid

Never use pejorative language or subjective characterizations:

• Avoid terms like "demanding," "rude," "ungrateful," "argumentative" in the medical record—these are subjective judgments 1
• Do not document suspicions about "making up" symptoms without objective evidence of factitious behavior (intentional symptom production) 1, 2
• Never assign psychiatric diagnosis codes based on difficult interpersonal dynamics alone 1, 3
• Do not use diagnosis codes as justification for practice discharge—this is ethically and legally problematic 1

The Appropriate Path Forward

Frame this as therapeutic relationship incompatibility:

• The American Academy of Child and Adolescent Psychiatry emphasizes that management of difficult behaviors should focus on the therapeutic relationship and whether it can be productive 1
• Document that "despite provider's efforts to accommodate patient preferences and address concerns, the therapeutic relationship has not been productive" 1
• State clearly: "Provider believes patient would benefit from care with a different provider who may be better suited to meet patient's needs and expectations" 1

Provide appropriate notice and transition:

• Offer 30 days of continued care for urgent needs while patient finds new provider 1
• Provide list of alternative providers or referral resources 1
• Document emergency care will remain available during transition 1

When Psychiatric Diagnosis Might Be Appropriate

Only consider psychiatric diagnosis codes if you have clear evidence of:

• Somatic symptom disorder: Multiple physical symptoms with excessive thoughts/anxiety about symptoms, lasting >6 months, with significant functional impairment—but this requires formal psychiatric evaluation, not provider frustration 1, 2
• Factitious disorder: Direct evidence of intentional symptom production (not just treatment non-response or demanding behavior), such as witnessed self-harm, laboratory evidence of substance ingestion, or documented falsification of medical records 1, 4, 5

The evidence shows that factitious disorder affects only 8% of psychiatric inpatients and requires specific proof of intentional symptom fabrication—your description does not meet these criteria 6.