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v1.0.0
ICD-10 Guide
ICD-10 CodesF13.1

F13.1

Billable

Sedative, hypnotic or anxiolytic-related abuse

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

Code Description

ICD-10 F13.1 is a billable code used to indicate a diagnosis of sedative, hypnotic or anxiolytic-related abuse.

Key Diagnostic Point:

F13.1 refers to the abuse of substances that are classified as sedatives, hypnotics, or anxiolytics. These substances are commonly prescribed for anxiety, sleep disorders, and other conditions but can lead to misuse and addiction. Individuals with sedative, hypnotic, or anxiolytic-related abuse may exhibit a pattern of consumption that leads to significant impairment or distress. Symptoms may include increased tolerance, withdrawal symptoms upon cessation, and continued use despite negative consequences. The clinical presentation can vary widely, from mild anxiety relief to severe impairment in daily functioning. Withdrawal symptoms can include anxiety, insomnia, tremors, and seizures, while intoxication may present with drowsiness, confusion, and respiratory depression. Treatment often involves a combination of behavioral therapies, counseling, and, in some cases, medication-assisted treatment to manage withdrawal symptoms and cravings. Understanding the nuances of this condition is crucial for effective diagnosis and treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of substances included under this code
  • Potential for co-occurring mental health disorders
  • Need for detailed documentation of substance use history
  • Variability in withdrawal symptoms and treatment approaches

Audit Risk Factors

  • Inadequate documentation of substance use history
  • Failure to document withdrawal symptoms
  • Misclassification of abuse versus dependence
  • Lack of evidence for treatment interventions

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Comprehensive substance use history, including duration and frequency of use, withdrawal symptoms, and treatment response.

Common Clinical Scenarios

Patients presenting with overdose, withdrawal symptoms, or seeking treatment for substance use.

Billing Considerations

Consideration of co-occurring mental health disorders and the need for multidisciplinary treatment approaches.

Psychiatry

Documentation Requirements

Detailed psychiatric evaluation, including mental status examination and assessment of substance use impact on mental health.

Common Clinical Scenarios

Patients with anxiety disorders who misuse prescribed medications or those with a history of substance use disorders.

Billing Considerations

Need for careful monitoring of medication prescriptions and potential for polypharmacy.

Coding Guidelines

Inclusion Criteria

Use F13.1 When
  • According to ICD
  • 10 guidelines, F13
  • 1 should be used when there is evidence of abuse without dependence
  • Documentation must support the diagnosis, including patterns of use and associated impairments

Exclusion Criteria

Do NOT use F13.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0031CPT Code

Mental health assessment

Clinical Scenario

Used when assessing a patient for substance use disorder.

Documentation Requirements

Document the assessment findings and treatment recommendations.

Specialty Considerations

Addiction specialists may require more detailed substance use histories.

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 track and treat sedative, hypnotic, or anxiolytic-related abuse effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of substance use disorders, improving the ability to track and treat sedative, hypnotic, or anxiolytic-related abuse effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of substance use disorders, improving the ability to track and treat sedative, hypnotic, or anxiolytic-related abuse effectively.

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 F13.1 and F13.0?

F13.1 indicates abuse without dependence, while F13.0 indicates a more severe level of dependence on sedatives, hypnotics, or anxiolytics.