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ICD-10 Guide
ICD-10 CodesF13.12

F13.12

Billable

Sedative, hypnotic or anxiolytic abuse with intoxication

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

Code Description

ICD-10 F13.12 is a billable code used to indicate a diagnosis of sedative, hypnotic or anxiolytic abuse with intoxication.

Key Diagnostic Point:

F13.12 refers to the abuse of sedative, hypnotic, or anxiolytic substances, characterized by a pattern of consumption that leads to significant impairment or distress. This condition is marked by the recurrent use of these substances, which can include benzodiazepines, barbiturates, and other medications that depress the central nervous system. Intoxication is defined by the presence of symptoms such as drowsiness, confusion, impaired coordination, and respiratory depression. Clinically, patients may present with a range of issues from mild sedation to severe overdose, necessitating careful monitoring and intervention. The diagnosis requires a thorough assessment of the patient's history, including the frequency and quantity of substance use, as well as any co-occurring mental health disorders. Treatment often involves a combination of detoxification, counseling, and support groups, with a focus on addressing both the substance use disorder and any underlying psychological issues.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of substances classified under sedatives, hypnotics, and anxiolytics.
  • Need for accurate assessment of intoxication severity.
  • Potential for co-occurring mental health disorders complicating diagnosis.
  • Variability in patient presentation and history.

Audit Risk Factors

  • Inadequate documentation of substance use history.
  • Failure to document the severity of intoxication.
  • Misclassification of intoxication versus withdrawal symptoms.
  • Lack of evidence for treatment interventions.

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Comprehensive substance use history, including types and amounts of substances used, duration of use, and previous treatment attempts.

Common Clinical Scenarios

Patients presenting with overdose symptoms, withdrawal management, and those seeking treatment for substance use disorders.

Billing Considerations

Consideration of co-occurring mental health disorders and the need for a multidisciplinary treatment approach.

Psychiatry

Documentation Requirements

Detailed psychiatric evaluation, including mental status examination and assessment of risk factors for substance use.

Common Clinical Scenarios

Patients with anxiety disorders using anxiolytics, those with insomnia using sedatives, and individuals presenting with mood disorders and substance abuse.

Billing Considerations

Importance of differentiating between primary psychiatric disorders and substance-induced symptoms.

Coding Guidelines

Inclusion Criteria

Use F13.12 When
  • According to ICD
  • 10 coding guidelines, F13
  • 12 should be used when there is clear evidence of abuse and intoxication
  • Documentation must support the diagnosis, including details of the substance used, frequency, and impact on the patient's life

Exclusion Criteria

Do NOT use F13.12 When
  • Exclusion criteria include cases where the substance use is not causing significant impairment

Related ICD-10 Codes

Related CPT Codes

H0031CPT Code

Mental health assessment

Clinical Scenario

Used when assessing a patient for substance use disorder.

Documentation Requirements

Document the assessment findings and treatment recommendations.

Specialty Considerations

Ensure that the assessment aligns with the diagnosis of F13.12.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including the differentiation between abuse and dependence, as well as the presence of intoxication. This specificity aids in better tracking and treatment of these conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including the differentiation between abuse and dependence, as well as the presence of intoxication. This specificity aids in better tracking and treatment of these conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including the differentiation between abuse and dependence, as well as the presence of intoxication. This specificity aids in better tracking and treatment of these conditions.

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 F13.12 and F13.10?

F13.12 is used when there is evidence of intoxication due to sedative, hypnotic, or anxiolytic abuse, while F13.10 is used when there is abuse without current intoxication symptoms.