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ICD-10 Guide
ICD-10 CodesF13.250

F13.250

Billable

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

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

Code Description

ICD-10 F13.250 is a billable code used to indicate a diagnosis of sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions.

Key Diagnostic Point:

F13.250 refers to a condition characterized by a dependence on sedative, hypnotic, or anxiolytic substances, which leads to the development of a psychotic disorder specifically induced by these substances. Patients with this diagnosis exhibit delusions, which are false beliefs that are firmly held despite evidence to the contrary. This condition often arises from prolonged use of medications such as benzodiazepines or barbiturates, which can alter brain chemistry and lead to significant psychological disturbances. The dependence manifests as a compulsive need to consume these substances, resulting in withdrawal symptoms when not taken. The psychotic disorder can present with various symptoms, including hallucinations, paranoia, and severe mood disturbances. Treatment typically involves a combination of detoxification, psychiatric support, and rehabilitation programs aimed at addressing both the substance dependence and the underlying mental health issues. Clinicians must carefully monitor patients for signs of withdrawal and psychosis, as these can complicate treatment and recovery.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between substance-induced psychotic disorders and primary psychotic disorders
  • Need for comprehensive documentation of substance use history
  • Potential for overlapping symptoms with other mental health disorders
  • Variability in treatment approaches based on severity and patient history

Audit Risk Factors

  • Inadequate documentation of substance use history
  • Failure to document the presence of delusions or psychotic symptoms
  • Misclassification of the type of substance dependence
  • Lack of evidence for treatment plans addressing both substance use and psychosis

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

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

Common Clinical Scenarios

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

Billing Considerations

Documentation must clearly differentiate between substance-induced symptoms and primary psychiatric disorders.

Addiction Medicine

Documentation Requirements

Comprehensive substance use history, treatment plans, and progress notes detailing withdrawal management.

Common Clinical Scenarios

Patients undergoing detoxification from sedatives with concurrent psychotic symptoms.

Billing Considerations

Focus on the integration of mental health treatment with substance use disorder management.

Coding Guidelines

Inclusion Criteria

Use F13.250 When
  • According to ICD
  • 10 guidelines, F13
  • 250 should be used when there is clear evidence of dependence on sedatives, hypnotics, or anxiolytics, accompanied by a psychotic disorder with delusions
  • Documentation must support the diagnosis, including details of substance use and the nature of the psychotic symptoms

Exclusion Criteria

Do NOT use F13.250 When
  • Exclusion criteria include primary psychotic disorders not related to substance use

Related ICD-10 Codes

Related CPT Codes

99214CPT Code

Established patient office visit, level 4

Clinical Scenario

Used for follow-up visits for patients with substance use disorders and psychotic symptoms.

Documentation Requirements

Detailed notes on patient history, mental status, and treatment progress.

Specialty Considerations

Psychiatrists should document the complexity of the case and any changes in treatment.

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. This specificity aids in better treatment planning and resource allocation.

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. This specificity aids in better treatment planning and resource allocation.

Reimbursement & Billing Impact

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. This specificity aids in better treatment planning and resource allocation.

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 significance of documenting delusions in patients with sedative dependence?

Documenting delusions is crucial as it differentiates the diagnosis from other mental health disorders and supports the need for specific treatment interventions. It also impacts the coding and billing process, ensuring that the complexity of the patient's condition is accurately represented.