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ICD-10 Guide
ICD-10 CodesF13.950

F13.950

Billable

Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions

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

Code Description

ICD-10 F13.950 is a billable code used to indicate a diagnosis of sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions.

Key Diagnostic Point:

F13.950 refers to a condition characterized by the use of sedative, hypnotic, or anxiolytic substances that leads to a psychotic disorder with delusions. This code is used when the specific substance is not identified, but the patient exhibits symptoms of psychosis, including delusions, as a direct result of substance use. Patients may present with altered mental status, hallucinations, and significant impairment in functioning. The psychotic symptoms can occur during intoxication or withdrawal phases and may require immediate medical intervention. Treatment typically involves stabilization, detoxification, and psychiatric support, including antipsychotic medications and counseling. Understanding the nuances of this code is crucial for accurate diagnosis and treatment planning, as well as for proper reimbursement and compliance with coding standards.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Unspecified substance use complicates diagnosis.
  • Differentiating between intoxication and withdrawal symptoms.
  • Need for comprehensive psychiatric evaluation.
  • Potential overlap with other mental health disorders.

Audit Risk Factors

  • Inadequate documentation of substance use history.
  • Failure to specify the type of sedative or anxiolytic used.
  • Lack of clear linkage between substance use and psychotic symptoms.
  • Misclassification of intoxication versus withdrawal.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed psychiatric evaluations, including history of substance use and mental status examinations.

Common Clinical Scenarios

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

Billing Considerations

Ensure that the documentation reflects the timeline of substance use and onset of psychotic symptoms.

Addiction Medicine

Documentation Requirements

Comprehensive substance use assessments and treatment plans.

Common Clinical Scenarios

Patients undergoing detoxification who exhibit psychotic symptoms.

Billing Considerations

Document the treatment approach, including any medications used to manage psychosis.

Coding Guidelines

Inclusion Criteria

Use F13.950 When
  • According to ICD
  • 10 coding guidelines, this code should be used when the psychotic disorder is directly linked to sedative, hypnotic, or anxiolytic use
  • Coders must ensure that the documentation supports the diagnosis and that the substance is unspecified
  • It is important to follow the inclusion criteria for substance

Exclusion Criteria

Do NOT use F13.950 When
  • induced disorders and to exclude other primary psychiatric disorders

Related ICD-10 Codes

Related CPT Codes

99214CPT Code

Established patient office visit, level 4

Clinical Scenario

Used when a patient with substance-induced psychosis is evaluated and managed in an outpatient setting.

Documentation Requirements

Document the history, examination, and medical decision-making related to the patient's substance use and psychotic symptoms.

Specialty Considerations

Psychiatrists should ensure that the visit notes reflect the complexity of the case.

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, improving the ability to capture the complexity of cases like F13.950. 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, improving the ability to capture the complexity of cases like F13.950. 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, improving the ability to capture the complexity of cases like F13.950. 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 significance of the unspecified nature of F13.950?

The unspecified nature indicates that the specific sedative, hypnotic, or anxiolytic used is not documented. This can complicate treatment and requires careful assessment to ensure appropriate management.