R45 Symptoms and signs involving emotional state

Notes on individual codes in R45

These annotations appear under the child codes in the FY2027 ICD-10-CM Tabular List. Codes not listed here carry no annotation of their own.

R45.0 Nervousness

Includes: Nervous tension

R45.3 Demoralization and apathy

Excludes1: anhedonia (R45.84)

R45.83 Excessive crying of child, adolescent or adult

Excludes1: excessive crying of infant (baby) R68.11

R45.85 Homicidal and suicidal ideations

Excludes1: suicide attempt (T14.91)

R45.88 Nonsuicidal self-harm

Includes: Nonsuicidal self-injury; Nonsuicidal self-mutilation; Self-inflicted injury without suicidal intent

Code also: injury, if known

R45.89 Other symptoms and signs involving emotional state

Includes: Flat affect; Loneliness

Coding notes for R45

• R45 is a three-character category heading and is not billable on its own. The Official Guidelines state that "a three-character code is to be used only if it is not further subdivided" and that diagnosis codes are reported "at their highest number of characters available". Of the 20 child codes listed above, 18 are billable and 2 are subcategory headings that need a further character.
• R45.8 and R45.85 are headings, not billable codes: R45.8 divides into R45.81 through R45.89, and R45.85 divides into R45.850 (homicidal ideations) and R45.851 (suicidal ideations). R45.0 through R45.7 are billable at four characters.
• Three subcodes carry their own Excludes1 notes: anhedonia (R45.84) under R45.3 (demoralization and apathy), excessive crying of infant (R68.11) under R45.83 (excessive crying of child, adolescent or adult), and suicide attempt (T14.91) under R45.85 (homicidal and suicidal ideations).
• R45.88 (nonsuicidal self-harm) lists nonsuicidal self-injury, nonsuicidal self-mutilation and self-inflicted injury without suicidal intent as inclusion terms, and has a "code also" note for the injury, if known.
• R45.0 (nervousness) lists nervous tension as an inclusion term; R45.89 (other symptoms and signs involving emotional state) lists flat affect and loneliness.

How to read the notes

Includes

Appears under a three-character code title "to further define, or give examples of, the content of the category."

Excludes1

"A type 1 Excludes note is a pure excludes note. It means 'NOT CODED HERE!'" The excluded code "should never be used at the same time as the code above the Excludes1 note."

Excludes2

"A type 2 Excludes note represents 'Not included here.'" The excluded condition is not part of this code, "but a patient may have both conditions at the same time", so both codes may be used together when appropriate.

Code first / Use additional code

Sequencing rules: when a "code first" note is present and an underlying condition is present, "the underlying condition should be sequenced first, if known."

Code also

"Two codes may be required to fully describe a condition, but this note does not provide sequencing direction."

Sources

• ICD-10-CM Files, FY2027 release (effective October 1, 2026) — CDC National Center for Health Statistics
• ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 — CDC/NCHS and CMS (the quoted conventions: Sections I.A.10–13, I.A.17, I.B.2, I.B.7, I.B.13)

Code titles, child codes and annotations are reproduced from the FY2027 ICD-10-CM release. This page is a reference, not coding or medical advice.