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ICD-10 Guide
ICD-10 CodesF12.250

F12.250

Billable

Cannabis dependence with psychotic disorder with delusions

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 F12.250 is a billable code used to indicate a diagnosis of cannabis dependence with psychotic disorder with delusions.

Key Diagnostic Point:

Cannabis dependence with psychotic disorder with delusions is characterized by a pattern of cannabis use that leads to clinically significant impairment or distress, accompanied by the presence of psychotic symptoms, specifically delusions. Patients may exhibit a strong craving for cannabis, tolerance to its effects, and withdrawal symptoms when not using the substance. The psychotic disorder manifests as delusions, which are fixed false beliefs that are resistant to reason or confrontation with actual fact. These delusions can significantly impair the individual's ability to function socially, occupationally, or in other important areas of life. The condition often requires a comprehensive treatment approach, including psychotherapy, medication management, and support groups, to address both the substance dependence and the underlying psychotic symptoms. Clinicians must carefully assess the severity of the dependence and the nature of the psychotic symptoms to develop an effective treatment plan that addresses both aspects of the disorder.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between substance-induced psychotic disorders and primary psychotic disorders.
  • Need for comprehensive documentation of both cannabis dependence and psychotic symptoms.
  • Potential for co-occurring mental health disorders complicating the diagnosis.
  • Variability in presentation of delusions and their impact on functioning.

Audit Risk Factors

  • Inadequate documentation of psychotic symptoms.
  • Failure to differentiate between substance-induced and primary psychotic disorders.
  • Lack of evidence for the severity of cannabis dependence.
  • Insufficient follow-up documentation on treatment response.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed psychiatric evaluation, including history of substance use and mental health symptoms.

Common Clinical Scenarios

Patients presenting with acute psychosis following cannabis use, chronic cannabis users developing delusions.

Billing Considerations

Careful monitoring of medication interactions and side effects, especially with antipsychotics.

Addiction Medicine

Documentation Requirements

Comprehensive substance use history, including patterns of use and withdrawal symptoms.

Common Clinical Scenarios

Patients in withdrawal experiencing psychotic symptoms, those in recovery with relapse episodes.

Billing Considerations

Integration of behavioral therapies and support systems in treatment plans.

Coding Guidelines

Inclusion Criteria

Use F12.250 When
  • According to ICD
  • 10 guidelines, F12
  • 250 should be used when there is clear evidence of cannabis dependence alongside a psychotic disorder characterized by delusions
  • Documentation must support the diagnosis, including the duration and severity of symptoms

Exclusion Criteria

Do NOT use F12.250 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99214CPT Code

Established patient office visit, level 4

Clinical Scenario

Used for follow-up visits to manage cannabis dependence and psychotic symptoms.

Documentation Requirements

Document history, examination findings, and treatment plan.

Specialty Considerations

Psychiatric evaluations may require additional documentation of mental status.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of cannabis-related disorders, improving the ability to capture the complexity of cases involving substance use and mental health issues.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of cannabis-related disorders, improving the ability to capture the complexity of cases involving substance use and mental health issues.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of cannabis-related disorders, improving the ability to capture the complexity of cases involving substance use and mental health issues.

Resources

Clinical References

  • •
    Substance Abuse and Mental Health Services Administration (SAMHSA)

Coding & Billing References

  • •
    Substance Abuse and Mental Health Services Administration (SAMHSA)

Frequently Asked Questions

What is the difference between F12.250 and F12.249?

F12.250 includes the presence of delusions as part of the psychotic disorder, while F12.249 does not specify delusions, indicating a broader range of psychotic symptoms.