ICD-10 Code F65.5 – Sadomasochism (2026): Diagnosis, Symptoms & Billing Guide
2026 ICD-10-CM Diagnosis Code F65.5 – Sadomasochism
What it is
F65.5 identifies sadomasochism, a paraphilic disorder involving recurrent sexual arousal from inflicting or receiving pain, humiliation, or bondage. Use it only when the behavior is clinically documented and relevant to care.
Clinical signs
Clinical features vary; refer to documentation. Records may describe persistent fantasies, urges, or behaviors involving sadistic or masochistic acts, especially when they cause distress, impairment, or involve nonconsenting persons.
When to use this code
Use F65.5 when the clinician documents sadomasochism as the diagnosis or a significant behavioral concern requiring assessment. It may apply in psychiatric evaluations, counseling notes, or problem lists when the condition is actively addressed.
Do not assign it for consensual sexual practices unless the documentation clearly supports a disorder. If the note is vague or only mentions sexual preference, check documentation before coding.
Do not use for
Do not use this code for general sexual activity, relationship conflict, or isolated erotic fantasies without a documented disorder. Also avoid it when the chart does not clearly distinguish consensual behavior from a clinical diagnosis.
Coding tip
Code only from explicit provider documentation and confirm whether the behavior is diagnosed as a disorder or merely described as a preference.