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ICD-10 Guide
ICD-10 CodesF06.2

F06.2

Billable

Psychotic disorder with delusions due to known physiological condition

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

Code Description

ICD-10 F06.2 is a billable code used to indicate a diagnosis of psychotic disorder with delusions due to known physiological condition.

Key Diagnostic Point:

F06.2 refers to a psychotic disorder characterized by the presence of delusions that arise as a direct consequence of a known physiological condition. This condition can manifest in various forms, including organic mental disorders, delirium, and personality changes due to medical conditions such as neurological disorders, metabolic imbalances, or substance-induced states. Patients may experience fixed false beliefs that are not aligned with reality, 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 guiding treatment. Common causes include brain injuries, infections, and chronic illnesses that affect brain function. Accurate diagnosis requires a thorough clinical evaluation, including a detailed medical history and appropriate diagnostic tests to identify the physiological condition contributing to the psychotic symptoms.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires clear documentation of the underlying physiological condition.
  • Differentiation from primary psychotic disorders can be challenging.
  • Need for comprehensive clinical evaluation and history.
  • Potential overlap with other mental health diagnoses.

Audit Risk Factors

  • Inadequate documentation of the physiological condition.
  • Failure to specify the type of delusions.
  • Misclassification as a primary psychotic disorder.
  • Lack of supporting clinical evidence for the diagnosis.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed psychiatric evaluation, including history of present illness, mental status examination, and documentation of the physiological condition.

Common Clinical Scenarios

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

Billing Considerations

Psychiatrists must ensure that the physiological condition is clearly linked to the psychotic symptoms to avoid misdiagnosis.

Neurology

Documentation Requirements

Comprehensive neurological assessment, imaging studies, and lab results to identify the underlying condition.

Common Clinical Scenarios

Patients with seizures or encephalitis presenting with delusions.

Billing Considerations

Neurologists should document the relationship between neurological findings and psychiatric symptoms.

Coding Guidelines

Inclusion Criteria

Use F06.2 When
  • According to ICD
  • 10 coding guidelines, F06
  • 2 should be used when the psychotic disorder is directly attributable to a known physiological condition
  • Coders must ensure that the underlying condition is documented and that the delusions are clearly described

Exclusion Criteria

Do NOT use F06.2 When
  • Exclusion criteria include primary psychotic disorders without a physiological basis

Related ICD-10 Codes

Related CPT Codes

90791CPT Code

Psychiatric diagnostic evaluation

Clinical Scenario

Used when evaluating a patient for F06.2 to establish the diagnosis.

Documentation Requirements

Comprehensive history and mental status examination.

Specialty Considerations

Psychiatrists should ensure that the evaluation includes assessment of the physiological condition.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more precise coding of psychotic disorders linked to physiological conditions, improving the ability to track and treat these patients effectively. It emphasizes the importance of documenting the underlying medical conditions that contribute to psychiatric symptoms.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more precise coding of psychotic disorders linked to physiological conditions, improving the ability to track and treat these patients effectively. It emphasizes the importance of documenting the underlying medical conditions that contribute to psychiatric symptoms.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more precise coding of psychotic disorders linked to physiological conditions, improving the ability to track and treat these patients effectively. It emphasizes the importance of documenting the underlying medical conditions that contribute to psychiatric symptoms.

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 F06.2 and primary psychotic disorders?

F06.2 is specifically for psychotic disorders with delusions that are directly caused by a known physiological condition, whereas primary psychotic disorders, such as schizophrenia, do not have an identifiable physiological cause.