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ICD-10 Guide
ICD-10 CodesF13.259

F13.259

Billable

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

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

Code Description

ICD-10 F13.259 is a billable code used to indicate a diagnosis of sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified.

Key Diagnostic Point:

F13.259 refers to a condition characterized by a dependence on sedative, hypnotic, or anxiolytic substances, accompanied by a psychotic disorder induced by these substances. Patients with this diagnosis often exhibit symptoms such as hallucinations, delusions, and disorganized thinking, which arise during periods of intoxication or withdrawal from these substances. The psychotic symptoms can significantly impair the individual's ability to function in daily life and may require immediate intervention. Dependence on these substances typically develops over time, often as a result of prolonged use for anxiety or sleep disorders. Treatment may involve a combination of detoxification, psychotherapy, and medication management to address both the substance dependence and the psychotic symptoms. Accurate diagnosis and coding are crucial for effective treatment planning and insurance reimbursement.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between substance-induced psychotic disorders and primary psychotic disorders.
  • Identifying the specific sedative, hypnotic, or anxiolytic involved.
  • Documenting the severity and duration of dependence and psychotic symptoms.
  • Understanding the nuances of withdrawal symptoms versus intoxication effects.

Audit Risk Factors

  • Inadequate documentation of psychotic symptoms.
  • Failure to specify the substance involved.
  • Misclassification of the severity of dependence.
  • Lack of evidence for the duration of symptoms.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed psychiatric evaluations, including history of substance use and mental health assessments.

Common Clinical Scenarios

Patients presenting with acute psychosis following sedative withdrawal or overdose.

Billing Considerations

Ensure clear documentation of the relationship between substance use and psychotic symptoms.

Addiction Medicine

Documentation Requirements

Comprehensive substance use history and treatment plans, including detoxification protocols.

Common Clinical Scenarios

Patients undergoing rehabilitation for sedative dependence with co-occurring psychotic symptoms.

Billing Considerations

Documenting the treatment approach and response to therapy is critical for accurate coding.

Coding Guidelines

Inclusion Criteria

Use F13.259 When
  • According to ICD
  • 10 coding guidelines, F13
  • 259 should be used when there is clear evidence of dependence on sedative, hypnotic, or anxiolytic substances along with psychotic symptoms
  • It is essential to document the specific substances involved and the nature of the psychotic disorder

Exclusion Criteria

Do NOT use F13.259 When
No specific exclusions found.

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 associated psychotic symptoms.

Documentation Requirements

Document the patient's history, mental status examination, and treatment plan.

Specialty Considerations

Psychiatrists should ensure comprehensive notes reflecting the complexity of the patient's condition.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more precise coding of substance use disorders, including the specification of psychotic disorders. This specificity aids in better treatment planning and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more precise coding of substance use disorders, including the specification of psychotic disorders. This specificity aids in better treatment planning and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more precise coding of substance use disorders, including the specification of psychotic disorders. 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 difference between F13.259 and F13.20?

F13.259 includes the presence of a psychotic disorder induced by sedative, hypnotic, or anxiolytic use, while F13.20 refers to uncomplicated dependence without psychotic features.