Crystal's MCW Coder Hub🧬ICD-10 CM F44.4 - Conversion disorder with motor symptom or deficit
Short Definition
Conversion disorder with motor symptom or deficit — neurological-like motor symptoms (weakness, paralysis, abnormal movements, gait disturbance, speech or swallowing problems) that are not fully explained by an underlying neurological or medical condition and are not intentionally produced.
Long Clinical Definition
ICD-10 CM F44.4 captures conversion disorder with motor symptom or deficit, a subtype of functional neurological symptom disorder (FND). Patients present with one or more motor symptoms mimicking neurological disease, yet careful clinical evaluation demonstrates incompatibility between the symptom pattern and any recognized neurological condition.
The symptoms are not intentionally produced — this distinguishes them from malingering (Z76.5) and factitious disorder (F68.1x). They are typically associated with psychological stressors, trauma, or unresolved conflicts, and must cause clinically significant distress or functional impairment to meet diagnostic thresholds.
Code Position in ICD-10-CM (Code Tree)
- F01-F99 Mental, behavioral and neurodevelopmental disorders
- F40-F48 Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders
- F44 Dissociative and conversion disorders
- F44.0 Dissociative amnesia
- F44.1 Dissociative fugue
- F44.2 Dissociative stupor
- F44.4 Conversion disorder with motor symptom or deficit
- F44.5 Conversion disorder with seizures or convulsions
- F44.6 Conversion disorder with sensory symptom or deficit
- F44.7 Conversion disorder with mixed symptom presentation
- F44.8 Other dissociative and conversion disorders
- F44.9 Dissociative and conversion disorder, unspecified
- F44 Dissociative and conversion disorders
- F40-F48 Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders
Common Motor Presentations
- Limb weakness or paralysis (monoplegia, hemiplegia without lesion).
- Abnormal involuntary movements — functional tremor, jerks, dystonia.
- Abnormal gait — astasia-abasia, functional ataxia, dragging gait.
- dysphonia, aphonia, or mutism.
- Functional dysphagia (swallowing difficulties without structural cause).
Includes / Excludes
Includes
- Conversion disorder with abnormal movement.
- Conversion disorder with speech symptoms.
- Conversion disorder with swallowing symptoms.
- Conversion disorder with weakness or paralysis.
- Dissociative motor disorders.
- Psychogenic Aphonia.
- Psychogenic dysphonia.
Excludes1 — Do NOT Use F44.4 When
- Factitious disorder imposed on self → F68.11.
- Malingering (intentional symptom production for external gain) → Z76.5.
- Somatic symptom disorder → F45.1 and related F45 codes.
- Symptoms fully explained by an identified neurological disease (e.g., stroke, MS, Parkinson disease) → use the neurological condition code instead.
Excludes2 — Can Coexist
- Other separately diagnosed dissociative disorders (F44.0, F44.1, F44.2, F44.7-F44.9) when clinically distinct and individually documented.
HCC / Risk Adjustment
- HCC status: F44.4 does not map to a CMS-HCC.
- Risk adjustment is typically driven by chronic comorbidities (major depression, PTSD, bipolar disorder) rather than the conversion/dissociative diagnosis itself.
- Coexisting mental health conditions that do carry HCC weight should be coded when documented.
MS-DRG Considerations
When F44.4 is the principal diagnosis for an inpatient psychiatric admission:
- Groups under MDC 19 - Mental Diseases and Disorders.
- Likely psychiatric DRGs (DRG 880-887 range depending on procedures, LOS, and comorbidities).
When F44.4 is a secondary diagnosis:
- May contribute to severity of illness but typically does not independently shift the DRG.
- A principal diagnosis of an R-code (symptom code such as R29.6 - Repeated falls, R26.x - Abnormalities of gait) may be used while workup is underway, with F44.4 added once the psychiatric diagnosis is confirmed.
wRVU and CPT Pairings
wRVUs apply to CPT codes, not ICD-10-CM. Common CPT pairings for F44.4:
Evaluation
| CPT | Description |
|---|---|
| 90791 | Psychiatric diagnostic evaluation (no medical services) |
| 90792 | Psychiatric diagnostic evaluation with medical services |
| 99204-99205 | New patient office E/M — neurology or psychiatry initial evaluation |
| 99213-99215 | Established patient office E/M — follow-up management |
Psychotherapy
| CPT | Description |
|---|---|
| 90832 | Individual psychotherapy, 30 minutes |
| 90834 | Individual psychotherapy, 45 minutes |
| 90837 | Individual psychotherapy, 60 minutes |
| 90833 | Psychotherapy add-on, 30 min with E/M |
| 90836 | Psychotherapy add-on, 45 min with E/M |
| 90838 | Psychotherapy add-on, 60 min with E/M |
Health Behavior Intervention
| CPT | Description |
|---|---|
| 96156 | Health behavior assessment/re-assessment |
| 96158 | Health behavior intervention, individual |
Assistant at Surgery
Not applicable. F44.4 is managed medically through psychiatry, psychology, neurology, and rehabilitation medicine. Surgical procedures are not part of the standard treatment pathway for conversion disorder.
Documentation Best Practices
- Explicitly state the diagnosis — “conversion disorder with motor symptom,” “functional neurological symptom disorder with motor symptoms,” or “dissociative motor disorder.”
- Document motor symptom specifics — type, distribution, onset, variability.
- Document neurological evaluation results — inconsistent exam findings, positive Hoover sign, non-anatomic distribution, normal imaging.
- Document psychological context — stressors, trauma history, temporal association between stressor and symptom onset.
- Document functional impact — mobility, ADLs, work, school, driving.
- Note that workup has not identified an organic cause accounting for the full symptom pattern.
Coding Guideline Highlights
- Assign F44.4 only when the clinician explicitly documents conversion disorder or functional neurological symptom disorder with motor symptoms.
- Do not assign based solely on “unexplained weakness” without a documented psychiatric/functional diagnosis.
- Do not assign when symptoms are intentionally produced (use Z76.5 or F68.1x instead).
- May be co-coded with anxiety, depressive, or trauma-related disorders (F32-F33, F41, F43.1x) when documented as comorbidities.
Coding Examples
Example 1 — Neurology Initial Evaluation
Scenario 28-year-old presents with acute left-leg weakness. Exam shows give-way weakness, positive Hoover sign, non-anatomic distribution. MRI brain/spine and EMG normal. Neurologist documents functional neurological symptom disorder with motor symptoms.
ICD-10-CM
- F44.4 - Conversion disorder with motor symptom or deficit.
- F41.1 - Generalized anxiety disorder (if documented).
CPT
- 99204 - New patient office E/M, moderate complexity.
Example 2 — Psychiatry Follow-Up with Psychotherapy
Scenario 35-year-old with functional gait disturbance and comorbid major depressive disorder. Psychiatry visit includes medication management and 45-minute psychotherapy.
ICD-10-CM
- F44.4 - Conversion disorder with motor symptom or deficit.
- F33.1 - Major depressive disorder, recurrent, moderate.
CPT
- 99214 - Established patient E/M.
- 90836 - Psychotherapy, 45 minutes with E/M (add-on).
- Modifier -25 on 99214 if payer requires separate identification of E/M from psychotherapy.
Example 3 — Inpatient Psychiatric Admission for Functional Paraplegia
Scenario 20-year-old admitted for sudden paraplegia. Extensive neurological workup negative. Combined psychiatry and neurology consensus diagnosis of conversion disorder with motor symptom. PT/OT and psych intervention initiated.
Principal Diagnosis
- F44.4 - Conversion disorder with motor symptom or deficit.
Secondary Diagnoses
- F43.10 - Post-traumatic stress disorder, unspecified (if documented).
CPT (professional)
- 99221-99223 - Initial inpatient E/M.
- 99231-99233 - Subsequent inpatient E/M.
- 90833/90836 - Psychotherapy add-on codes as applicable.