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ICD-10 Guide
ICD-10 CodesF63.0

F63.0

Billable

Pathological gambling

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

Code Description

ICD-10 F63.0 is a billable code used to indicate a diagnosis of pathological gambling.

Key Diagnostic Point:

Pathological gambling, classified under ICD-10 code F63.0, is characterized by a persistent and recurrent problematic gambling behavior that leads to significant impairment or distress. Individuals with this condition often exhibit an inability to control their gambling impulses, resulting in adverse consequences in various aspects of life, including personal relationships, employment, and financial stability. The disorder is often associated with other mental health issues, such as anxiety and depression, and may co-occur with personality disorders, particularly those involving impulsivity and maladaptive behaviors. Pathological gambling is recognized as an impulse control disorder, where the individual experiences a compulsion to gamble despite the negative repercussions. The condition can manifest in various forms, including excessive betting on sports, casino games, or online gambling platforms. Treatment typically involves psychotherapy, support groups, and sometimes pharmacotherapy to manage underlying psychological issues. Understanding the nuances of this disorder is crucial for accurate diagnosis and coding, as it can significantly impact treatment planning and insurance reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of gambling behavior
  • Overlap with other mental health disorders
  • Need for comprehensive documentation of gambling history
  • Potential for co-occurring substance use disorders

Audit Risk Factors

  • Inadequate documentation of gambling history
  • Failure to document co-occurring mental health conditions
  • Lack of evidence for the impact of gambling on daily functioning
  • Misclassification of gambling behavior severity

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed patient history, including gambling patterns, psychological evaluations, and treatment plans.

Common Clinical Scenarios

Patients presenting with anxiety, depression, or relationship issues stemming from gambling behavior.

Billing Considerations

Consideration of comorbid conditions and their impact on treatment outcomes.

Addiction Medicine

Documentation Requirements

Comprehensive assessment of gambling behavior, including triggers and coping mechanisms.

Common Clinical Scenarios

Patients seeking help for gambling addiction alongside substance use disorders.

Billing Considerations

Integration of behavioral therapies and support group involvement in treatment plans.

Coding Guidelines

Inclusion Criteria

Use F63.0 When
  • According to the ICD
  • 10 coding guidelines, F63
  • 0 should be used when the gambling behavior is persistent and leads to significant impairment or distress
  • It is essential to document the duration and impact of the gambling behavior on the patient's life

Exclusion Criteria

Do NOT use F63.0 When
  • Exclusion criteria include gambling behavior that is not recurrent or does not cause significant distress

Related ICD-10 Codes

Related CPT Codes

90834CPT Code

Psychotherapy, 45 minutes with patient

Clinical Scenario

Used for therapy sessions addressing gambling addiction.

Documentation Requirements

Document the focus of therapy on gambling behaviors and coping strategies.

Specialty Considerations

Psychiatrists should note the impact of gambling on mental health.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of pathological gambling, facilitating better tracking of the disorder and its treatment outcomes. This specificity aids in research and improves the understanding of the condition within the healthcare system.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological gambling, facilitating better tracking of the disorder and its treatment outcomes. This specificity aids in research and improves the understanding of the condition within the healthcare system.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of pathological gambling, facilitating better tracking of the disorder and its treatment outcomes. This specificity aids in research and improves the understanding of the condition within the healthcare system.

Resources

Clinical References

  • •
    National Council on Problem Gambling

Coding & Billing References

  • •
    National Council on Problem Gambling

Frequently Asked Questions

What are the key symptoms of pathological gambling?

Key symptoms include a preoccupation with gambling, the need to gamble with increasing amounts of money, unsuccessful attempts to control gambling, and continued gambling despite negative consequences.