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ICD-10 Guide
ICD-10 CodesF06.0

F06.0

Billable

Psychotic disorder with hallucinations due to known physiological condition

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

Code Description

ICD-10 F06.0 is a billable code used to indicate a diagnosis of psychotic disorder with hallucinations due to known physiological condition.

Key Diagnostic Point:

F06.0 refers to a psychotic disorder characterized by hallucinations that arise as a direct consequence of a known physiological condition. This can include various organic mental disorders, such as those resulting from neurological diseases, metabolic disorders, or substance-induced conditions. Patients may experience auditory, visual, or tactile hallucinations, which can significantly impair their functioning and quality of life. The underlying physiological condition must be clearly documented, as it is essential for establishing the diagnosis and ensuring appropriate treatment. Common causes include brain injuries, infections, or chronic illnesses that affect brain function. The diagnosis requires a comprehensive evaluation, including a thorough medical history, physical examination, and possibly neuroimaging or laboratory tests to identify the underlying condition. Treatment typically involves addressing the physiological cause, alongside psychiatric interventions to manage the psychotic symptoms.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for comprehensive documentation of the underlying physiological condition
  • Differentiation from primary psychotic disorders
  • Potential overlap with other mental health diagnoses
  • Variability in presentation based on the underlying condition

Audit Risk Factors

  • Inadequate documentation of the physiological condition
  • Failure to specify the type of hallucinations experienced
  • Misclassification as a primary psychotic disorder
  • Lack of interdisciplinary notes linking physical and mental health

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed psychiatric evaluation notes, including symptom descriptions and their impact on functioning.

Common Clinical Scenarios

Patients with neurological disorders presenting with hallucinations, such as those with dementia or traumatic brain injury.

Billing Considerations

Ensure that the physiological condition is clearly documented and linked to the psychotic symptoms.

Neurology

Documentation Requirements

Neurological assessments, imaging results, and laboratory findings that support the diagnosis.

Common Clinical Scenarios

Patients with stroke or neurodegenerative diseases exhibiting psychotic symptoms.

Billing Considerations

Collaboration with psychiatry for comprehensive care and accurate coding.

Coding Guidelines

Inclusion Criteria

Use F06.0 When
  • According to ICD
  • 10 coding guidelines, F06
  • 0 should be used when hallucinations are directly attributable to a known physiological condition
  • Coders must ensure that the underlying condition is documented and that the hallucinations are not better explained by a primary psychiatric disorder

Exclusion Criteria

Do NOT use F06.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

90791CPT Code

Psychiatric diagnostic evaluation

Clinical Scenario

Used when evaluating a patient with hallucinations due to a physiological condition.

Documentation Requirements

Comprehensive history and mental status examination.

Specialty Considerations

Psychiatric evaluations should include details of the physiological condition.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of psychotic disorders related to physiological conditions, improving the accuracy of diagnoses and treatment plans. It emphasizes the need for clear documentation of the underlying causes of psychosis.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of psychotic disorders related to physiological conditions, improving the accuracy of diagnoses and treatment plans. It emphasizes the need for clear documentation of the underlying causes of psychosis.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of psychotic disorders related to physiological conditions, improving the accuracy of diagnoses and treatment plans. It emphasizes the need for clear documentation of the underlying causes of psychosis.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between F06.0 and F20?

F06.0 is used for psychotic disorders with hallucinations due to known physiological conditions, while F20 is for schizophrenia, a primary psychiatric disorder without a known physiological cause.