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ICD-10 Guide
ICD-10 CodesF13.959

F13.959

Billable

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

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

Code Description

ICD-10 F13.959 is a billable code used to indicate a diagnosis of sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified.

Key Diagnostic Point:

F13.959 refers to a condition characterized by the use of sedative, hypnotic, or anxiolytic substances that leads to a psychotic disorder. This code is used when the specific substance is not identified, and the psychotic symptoms are a direct result of the substance use. Patients may experience hallucinations, delusions, or disorganized thinking as a result of intoxication or withdrawal from these substances. The diagnosis requires careful assessment of the patient's history, including the duration and amount of substance use, as well as the presence of psychotic symptoms. Treatment typically involves a combination of detoxification, psychiatric support, and possibly medication to manage symptoms. Understanding the nuances of this code is essential for accurate documentation and billing, as it reflects both the substance use disorder and the resultant mental health complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Unspecified nature of substance use complicates coding.
  • Requires differentiation between substance-induced and primary psychotic disorders.
  • Need for comprehensive patient history to establish diagnosis.
  • Potential overlap with other substance use disorders.

Audit Risk Factors

  • Inadequate documentation of substance use history.
  • Failure to specify the nature of psychotic symptoms.
  • Misclassification of primary vs. substance-induced disorders.
  • Lack of evidence for the relationship between substance use and psychosis.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed psychiatric evaluation and history of substance use.

Common Clinical Scenarios

Patients presenting with acute psychosis following sedative use.

Billing Considerations

Differentiating between primary psychotic disorders and those induced by substance use.

Addiction Medicine

Documentation Requirements

Comprehensive assessment of substance use patterns and withdrawal symptoms.

Common Clinical Scenarios

Patients undergoing detoxification with concurrent psychotic symptoms.

Billing Considerations

Coordination of care with mental health services for dual diagnosis.

Coding Guidelines

Inclusion Criteria

Use F13.959 When
  • According to ICD
  • 10 guidelines, this code should be used when the psychotic disorder is directly linked to sedative, hypnotic, or anxiolytic use
  • Documentation must support the diagnosis, including the timeline of substance use and onset of psychotic symptoms

Exclusion Criteria

Do NOT use F13.959 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 substance use and psychotic symptoms.

Documentation Requirements

Document the patient's history, mental status exam, and treatment plan.

Specialty Considerations

Psychiatrists should include details on substance use history and current 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 substance use disorders, enabling better tracking of treatment outcomes and resource allocation for mental health services.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of substance use disorders, enabling better tracking of treatment outcomes and resource allocation for mental health services.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of substance use disorders, enabling better tracking of treatment outcomes and resource allocation for mental health services.

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 F13.959 and F13.10?

F13.959 includes the presence of a psychotic disorder as a result of sedative, hypnotic, or anxiolytic use, while F13.10 refers to the use of these substances without specifying any associated mental health disorders.