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ICD-10 Guide
ICD-10 CodesF12.95

F12.95

Billable

Cannabis use, unspecified with psychotic disorder

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

Code Description

ICD-10 F12.95 is a billable code used to indicate a diagnosis of cannabis use, unspecified with psychotic disorder.

Key Diagnostic Point:

F12.95 refers to a condition characterized by the use of cannabis that leads to the development of a psychotic disorder. This diagnosis is often seen in individuals who consume cannabis in varying amounts and frequencies, leading to symptoms such as hallucinations, delusions, and disorganized thinking. The psychotic disorder may manifest during intoxication or as a result of withdrawal from cannabis. The severity of symptoms can vary widely, and the diagnosis is often complicated by the presence of other substance use disorders or mental health conditions. Treatment typically involves a combination of psychotherapy, medication management, and support groups. Clinicians must carefully assess the patient's history of cannabis use, the duration and frequency of use, and any co-occurring mental health issues to provide an accurate diagnosis and effective treatment plan. Proper documentation is essential to support the diagnosis and ensure appropriate coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in symptom presentation among patients
  • Need for comprehensive patient history to differentiate from other disorders
  • Potential for co-occurring substance use disorders
  • Documentation requirements for psychotic symptoms

Audit Risk Factors

  • Inadequate documentation of psychotic symptoms
  • Failure to document the duration and frequency of cannabis use
  • Misclassification of the disorder as a primary diagnosis
  • Lack of evidence for co-occurring mental health conditions

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with acute psychosis following cannabis use, or chronic cannabis users developing psychotic symptoms.

Billing Considerations

Ensure clear documentation of the timeline of cannabis use in relation to the onset of psychotic symptoms.

Addiction Medicine

Documentation Requirements

Comprehensive substance use history, including patterns of use and previous treatment attempts.

Common Clinical Scenarios

Patients in withdrawal experiencing psychotic symptoms or those in recovery with a history of cannabis use.

Billing Considerations

Document any co-occurring disorders and treatment plans that address both substance use and mental health.

Coding Guidelines

Inclusion Criteria

Use F12.95 When
  • According to ICD
  • 10 coding guidelines, F12
  • 95 should be used when cannabis use leads to a psychotic disorder without specifying the type of psychotic disorder
  • It is essential to document the patient's history and symptoms accurately to justify the use of this code

Exclusion Criteria

Do NOT use F12.95 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

90791CPT Code

Psychiatric diagnostic evaluation

Clinical Scenario

Used when assessing a patient with cannabis use and psychotic symptoms.

Documentation Requirements

Comprehensive evaluation notes detailing history, symptoms, and treatment plan.

Specialty Considerations

Psychiatrists should ensure thorough documentation of substance use history.

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 track and treat these conditions effectively. F12.95 provides a clear framework for identifying patients with cannabis use and associated psychotic disorders.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of cannabis-related disorders, improving the ability to track and treat these conditions effectively. F12.95 provides a clear framework for identifying patients with cannabis use and associated psychotic disorders.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of cannabis-related disorders, improving the ability to track and treat these conditions effectively. F12.95 provides a clear framework for identifying patients with cannabis use and associated psychotic disorders.

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 F12.95 and F12.94?

F12.95 is used when cannabis use leads to a psychotic disorder that is unspecified, while F12.94 is used when specific psychotic symptoms are documented as being directly caused by cannabis use.