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ICD-10 Guide
ICD-10 CodesF13.251

F13.251

Billable

Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations

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

Code Description

ICD-10 F13.251 is a billable code used to indicate a diagnosis of sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations.

Key Diagnostic Point:

F13.251 refers to a condition characterized by a dependence on sedative, hypnotic, or anxiolytic substances, which leads to a psychotic disorder manifesting as hallucinations. Patients with this diagnosis typically exhibit a pattern of compulsive use of these substances, resulting in significant impairment in social, occupational, or other important areas of functioning. The psychotic disorder is directly induced by the substance use, and the hallucinations can be auditory, visual, or tactile in nature. This condition often requires comprehensive treatment strategies, including detoxification, psychotherapy, and possibly pharmacotherapy to manage both the dependence and the psychotic symptoms. The interplay between substance use and mental health is complex, necessitating careful assessment and tailored interventions to address both the addiction and the resultant psychiatric manifestations.

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 substance use history and current symptoms.
  • Potential for co-occurring mental health disorders complicating the diagnosis.
  • Variability in presentation of psychotic symptoms based on individual patient factors.

Audit Risk Factors

  • Inadequate documentation of substance use history.
  • Failure to document the presence and type of hallucinations.
  • Misclassification of the psychotic disorder as primary rather than substance-induced.
  • Lack of evidence for treatment plans addressing both substance dependence and psychotic symptoms.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed patient history, including substance use patterns and mental health evaluations.

Common Clinical Scenarios

Patients presenting with acute psychosis following sedative use, or those in withdrawal experiencing hallucinations.

Billing Considerations

Ensure clear differentiation between substance-induced and primary psychiatric disorders.

Addiction Medicine

Documentation Requirements

Comprehensive assessment of substance use, including frequency, duration, and impact on functioning.

Common Clinical Scenarios

Patients undergoing detoxification who exhibit psychotic symptoms.

Billing Considerations

Focus on integrated treatment approaches that address both addiction and mental health.

Coding Guidelines

Inclusion Criteria

Use F13.251 When
  • According to ICD
  • 10 guidelines, F13
  • 251 should be used when there is clear evidence of dependence on sedative, hypnotic, or anxiolytic substances accompanied by a psychotic disorder with hallucinations
  • Documentation must support the diagnosis, including substance use history and the nature of psychotic symptoms

Exclusion Criteria

Do NOT use F13.251 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 for patients with sedative dependence and psychotic symptoms.

Documentation Requirements

Document the patient's history, current symptoms, and treatment plan.

Specialty Considerations

Psychiatrists should focus on both mental health and substance use aspects.

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 of dependence and associated psychotic disorders. This specificity aids in better treatment planning and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including the differentiation of dependence and associated psychotic disorders. This specificity aids in better treatment planning and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including the differentiation of dependence and associated psychotic disorders. This specificity aids in better treatment planning and resource allocation.

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 F13.251 and F13.20?

F13.251 includes the additional complexity of a psychotic disorder with hallucinations, while F13.20 refers to uncomplicated sedative, hypnotic, or anxiolytic dependence.