ICD-10 Codes for Suicide Attempt & Ideation

If you or someone you know is in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline ↗, available 24/7. This page is clinical coding documentation for healthcare professionals.

The ICD-10-CM code for a suicide attempt is T14.91X- — an injury-chapter code with a required 7th character — not an F-code. Suicidal ideation is R45.851, and personal history of suicidal behavior is Z91.51. Behavioral health teams document suicidality every day, and the coding spans three chapters of ICD-10-CM, each with its own rules. This guide maps the full constellation as published in the FY2026 ICD-10-CM code set ↗ and the sequencing logic that connects the codes.

This page is part of our ICD-10 directory for behavioral health.

The code constellation

All titles verified against the FY2026 tabular list. Three structural details worth pinning down:

The 7th character is not optional. T14.91 sits in category T14 (injury of unspecified body region), which carries the standard Chapter 19 7th-character requirement. The placeholder X fills the 6th position, so the valid billable codes are T14.91XA, T14.91XD, and T14.91XS. Per the Official Guidelines ↗ Section I.C.19.a, the 7th character tracks whether the patient is receiving active treatment for the injury — not whether your facility is seeing the patient for the first time.

Specific beats unspecified. T14.91X- is the attempt code for unspecified means. When the record documents the actual injury or poisoning, ICD-10-CM expects the specific condition coded with self-harm intent — poisoning and toxic-effect codes (T36–T50 range) build intent into their character structure, and other injuries pair with the intentional self-harm external cause codes (X71–X83 range).

The FY2022 vintage test. R45.88, Z91.51, and Z91.52 were added effective October 1, 2021 — we verified by comparing the CMS FY2021 and FY2022 code files (absent in FY2021, present in FY2022). Code lists, cheat sheets, and competitor pages that omit them — or that still describe “history of self-harm” with only Z91.5 — predate FY2022 and have not been maintained.

Sequencing rules

The codes above combine on real claims, and order matters:

• Attempt this encounter: injury first, psychiatric condition additionally. When an encounter is for a suicide attempt, the injury or poisoning is the reason for the encounter and sequences first; the underlying psychiatric diagnosis — major depressive disorder, bipolar disorder, or another condition — is coded additionally. For the mood-disorder side of those claims, see our F30–F39 guide.
• Never code ideation when an attempt occurred this encounter. The FY2026 tabular puts an Excludes1 note on R45.85: “suicide attempt (T14.91).” Excludes1 means the two are mutually exclusive on the same encounter — the attempt code subsumes the ideation.
• Ideation as a symptom code. R45.851 follows Chapter 18 logic (Guidelines I.C.18.a–b): it is reportable in its own right, and also reportable alongside a definitive psychiatric diagnosis when the ideation is clinically significant — suicidal ideation is not “routinely associated” with any single diagnosis. In behavioral health practice it is routinely coded secondary to the primary psychiatric diagnosis.
• History codes ride along. Z91.51 and Z91.52 are Chapter 21 personal-history codes (Guidelines I.C.21.c.4): they describe a past condition no longer under active treatment that retains recurrence risk, and they are “acceptable on any medical record regardless of the reason for visit.” They are additional diagnoses, never first-listed for a treatment encounter.

Documenting suicidality at behavioral health facilities

Coding accuracy downstream depends on assessment documentation upstream:

• Standardized screening. The Joint Commission ’s National Patient Safety Goal on suicide prevention — NPSG 15.01.01 — requires accredited behavioral health organizations to screen patients for suicidal ideation using a validated tool and to document risk and mitigation plans. The screening result is the documentation anchor for R45.851: a positive screen plus clinical assessment supports the code; the code without the assessment is an audit finding waiting to happen. (Reference validated tools by name in documentation — e.g., the Columbia protocol — without reproducing their items, which are licensed instruments.)
• Safety planning. A documented safety plan — warning signs, internal coping strategies, support contacts, lethal-means counseling, crisis resources including 988 — is both the standard of care and the medical-necessity evidence that the facility identified and is actively managing risk.
• Admission medical necessity. A recent attempt or active ideation with plan is among the clearest acuity drivers for inpatient and residential admission. The intake documentation should state the attempt or ideation, its recency, current risk formulation, and why a lower level of care cannot safely manage it — that paragraph is what the T14.91XD/Z91.51/R45.851 codes on the claim point back to.
• Treatment-plan integration. Risk assessment belongs in every treatment plan review for clients with suicidality history, with goals and interventions that reference it explicitly.

Ideation vs. attempt vs. history: the decision table

The step-down documentation habit: when a client moves from inpatient to residential to PHP/IOP after an attempt, Z91.51 belongs on every subsequent treatment plan and claim once active injury treatment has ended. It is the code that keeps the risk history visible across the episode of care — supporting continued-stay reviews at lower levels and keeping utilization reviewers from reading a step-down chart as a routine mood-disorder admission.

Choosing the 7th character at behavioral health facilities

The A/D/S choice on T14.91X- follows active treatment for the injury, per Guidelines I.C.19.a — and behavioral health facilities usually enter the timeline after the emergency phase, which makes D and S the workhorses:

Fictional example: a client is hospitalized after an attempt (acute phase coded by the hospital with A), discharges to residential care ten days later, and steps down to PHP after five weeks. The residential facility’s claims carry the psychiatric diagnosis first-listed for treatment encounters, with T14.91XD while attempt-related recovery care continues — transitioning to Z91.51 as the history code once no encounter care addresses the attempt itself. The PHP claims carry the psychiatric diagnosis plus Z91.51.

• A — initial encounter applies while the patient is receiving active treatment for the attempt itself. This is typically the ED and acute medical/psychiatric hospitalization phase. A BH facility would rarely originate an A-coded claim unless the attempt occurred on-site and its providers delivered the acute response.
• D — subsequent encounter applies during recovery-phase care related to the attempt. A residential admission two weeks after an attempt, where the treatment plan still addresses recovery from the event, fits the subsequent-encounter concept. Note the guideline’s reminder: a new provider does not reset the encounter to “initial” — the question is the treatment phase, not who is rendering it.
• S — sequela applies when a late effect of the attempt is itself being treated; the sequela code pairs with the code for the specific late effect.

Common coding errors

• Bare T14.91 on the claim. Missing 7th character — rejects as invalid. The placeholder X must fill position six.
• R45.851 and T14.91X- on the same encounter. The R45.85 Excludes1 bars it; the attempt code controls.
• Ideation coded from a screening checkbox. A positive screen routes to clinical assessment; the code should reflect the clinician’s risk assessment, not the screening instrument alone.
• Dropping the history. Z91.51 missing from step-down claims is the most consequential omission — it removes the acuity context exactly when continued-stay justification needs it most.
• Forgetting the psychiatric diagnosis. T14.91X- describes the event, not the illness. The underlying mood, trauma-related, or substance use disorder belongs on the claim and in the treatment plan.

Billing and utilization review

How the constellation plays in revenue cycle work:

Facilities running this documentation chain — validated screening at intake, risk assessment in every note, safety plans, and diagnosis codes that flow to claims — benefit from an EHR built for behavioral health risk workflows. ’s EHR supports structured assessments, treatment-plan integration, and claims that carry the full diagnosis picture. Request a Demo: contact us.

• Acuity narrative for continued stays. R45.851 and Z91.51 as secondary diagnoses materially change a concurrent review. Recent suicidality is central to why a client needs 24-hour structure rather than outpatient care — if it is documented in the chart but missing from the claim, the claim undersells the acuity that justifies the authorization.
• Crisis service codes. Encounters dominated by active suicidality assessment and stabilization may meet the requirements for crisis psychotherapy CPT codes 90839 and 90840 — diagnosis codes and service codes should tell the same story.
• Expect records requests, not auto-denials. Attempt and ideation codes draw scrutiny because they are high-acuity claims; clean, dated risk assessments and safety plans resolve most of them. Patterned problems — R45.851 on every claim from a screening checkbox without assessment documentation, or 7th-character errors on T14.91X- — are what turn reviews into recoupments.
• Denial tracking. If suicidality-related claims are denying, the fix is usually documentation workflow, not coding. Tracking denial reasons by diagnosis cluster makes that visible — see revenue cycle management.

Sources: FY2026 ICD-10-CM code set and tabular list ↗ (CMS, effective Oct 1, 2025); ICD-10-CM Official Guidelines for Coding and Reporting, FY2026 ↗, Sections I.C.18, I.C.19.a, I.C.21.c.4; The Joint Commission, National Patient Safety Goals ↗; 988 Suicide & Crisis Lifeline ↗. Accessed June 2026.

Crisis resources: call or text 988, or chat at 988lifeline.org ↗. The Lifeline provides free, confidential support 24/7.

Reference tables

Common questions

Official sources

• FY2026 ICD-10-CM code setcms.gov
• Official Guidelinescms.gov
• The Joint Commission, National Patient Safety Goalsjointcommission.org