Coding Aggression

by  Wyn Staheli, Director of Content - innoviHealth
Jul 13th, 2026

Technically, aggression and violence are related concepts but are not synonymous. In behavioral health, aggressive and violent behavior are signs or symptoms which may be part of a condition such as conduct disorder (F91.-). Professional judgment is required to determine the appropriate code to use since there is no specific ICD-10-CM code that describes aggression alone.

According to DSM, conduct disorder is described as behaviors that violate the rights of others (e.g., aggression, destruction of property) and/or bring the individual into significant conflict with societal norms or authority figures. To be diagnosed with conduct disorder, at least 3 symptoms must be present in the past 12 months with one symptom having been present in the past 6 months. In addition, the symptoms must cause significant impairment in social, academic, or occupational functioning.

In order to report a code from category F91, aggression or violence must be present for at least 6 months. If this is an acute episode or an ongoing symptom that does not meet the criteria for conduct disorder, then some professionals recommend the use of R45.6 "Violent behavior" even if the aggression doesn't meet what is generally considered violent behavior because of the way that DSM describes conduct disorder. Others have used code R46.89 "Other symptoms and signs involving appearance and behavior". According to the Medicare Code Editor, code R46.89 is a secondary diagnosis only, so it should not be reported first on a claim.

Since there are no other official published guidelines regarding the use of either of these codes, use your professional judgment about which code is appropriate to use when reporting aggression.