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ICD-10 Guide
ICD-10 CodesF13.25

F13.25

Billable

Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder

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

Code Description

ICD-10 F13.25 is a billable code used to indicate a diagnosis of sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder.

Key Diagnostic Point:

F13.25 refers to a condition characterized by a dependence on sedative, hypnotic, or anxiolytic substances, which leads to the development of a psychotic disorder induced by these substances. Patients with this diagnosis often exhibit symptoms such as hallucinations, delusions, and severe mood disturbances that are directly attributable to the use of these medications. The dependence may manifest as a compulsive need to consume these substances, leading to significant impairment in social, occupational, or other important areas of functioning. Withdrawal symptoms can include anxiety, agitation, and seizures, which may further complicate the clinical picture. Treatment typically involves a combination of detoxification, psychological support, and rehabilitation programs aimed at addressing both the substance use disorder and the associated psychotic symptoms. Clinicians must carefully monitor patients for both withdrawal and the potential for relapse, as well as the need for ongoing psychiatric care.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between substance-induced psychotic disorders and primary psychotic disorders.
  • Understanding the nuances of substance dependence versus substance abuse.
  • The need for comprehensive documentation of both substance use and psychiatric symptoms.
  • Potential for co-occurring mental health disorders complicating the diagnosis.

Audit Risk Factors

  • Inadequate documentation of the psychotic symptoms and their relationship to substance use.
  • Failure to document the severity and duration of substance dependence.
  • Lack of evidence for comprehensive treatment plans.
  • Misclassification of the disorder as a primary psychotic disorder.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed psychiatric evaluations, including mental status exams and history of substance use.

Common Clinical Scenarios

Patients presenting with acute psychosis following sedative use, or those in withdrawal experiencing psychotic symptoms.

Billing Considerations

Documentation must clearly differentiate between substance-induced symptoms and any underlying psychiatric conditions.

Addiction Medicine

Documentation Requirements

Comprehensive substance use history, including patterns of use, withdrawal symptoms, and treatment responses.

Common Clinical Scenarios

Patients undergoing detoxification who exhibit psychotic symptoms related to sedative use.

Billing Considerations

Focus on the integration of mental health and addiction treatment plans.

Coding Guidelines

Inclusion Criteria

Use F13.25 When
  • According to ICD
  • 10 guidelines, F13
  • 25 should be used when there is clear evidence of dependence on sedatives, hypnotics, or anxiolytics, accompanied by psychotic symptoms
  • Documentation must support the diagnosis, including the timeline of substance use and the onset of psychotic symptoms

Exclusion Criteria

Do NOT use F13.25 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0031CPT Code

Mental health assessment

Clinical Scenario

Used during initial evaluation of a patient with suspected substance-induced psychosis.

Documentation Requirements

Comprehensive assessment notes detailing mental status and substance use history.

Specialty Considerations

Psychiatric evaluations must be thorough to support the diagnosis.

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, including the differentiation of psychotic disorders induced by substance use, which enhances the accuracy of treatment and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including the differentiation of psychotic disorders induced by substance use, which enhances the accuracy of treatment and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

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 F13.25 and F13.20?

F13.25 includes the presence of a psychotic disorder induced by sedative, hypnotic, or anxiolytic use, while F13.20 indicates dependence without such psychotic features.