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ICD-10 Guide
ICD-10 CodesF13.26

F13.26

Billable

Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder

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

Code Description

ICD-10 F13.26 is a billable code used to indicate a diagnosis of sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder.

Key Diagnostic Point:

F13.26 refers to a condition characterized by a dependence on sedative, hypnotic, or anxiolytic substances, which leads to a persisting amnestic disorder. This disorder is marked by significant memory impairment that persists even after the cessation of substance use. Patients may experience difficulties in forming new memories or recalling past events, which can severely impact their daily functioning and quality of life. The dependence on these substances often develops through prolonged use, leading to tolerance and withdrawal symptoms when not using the drug. The amnestic disorder is a direct result of the neurotoxic effects of these substances on the brain, particularly affecting areas involved in memory processing. Treatment typically involves a combination of detoxification, cognitive rehabilitation, and psychotherapy to address both the substance use disorder and the cognitive deficits caused by the substance use.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between dependence and withdrawal symptoms
  • Identifying persisting amnestic disorder versus other cognitive disorders
  • Need for comprehensive documentation of substance use history
  • Potential for co-occurring mental health disorders

Audit Risk Factors

  • Inadequate documentation of substance use history
  • Failure to document the severity of amnestic symptoms
  • Misclassification of the type of substance used
  • Lack of evidence for treatment interventions

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed history of substance use, mental status examination, and cognitive assessment.

Common Clinical Scenarios

Patients presenting with memory loss and a history of sedative use, requiring evaluation for dependence.

Billing Considerations

Consideration of other psychiatric disorders that may complicate the diagnosis.

Addiction Medicine

Documentation Requirements

Comprehensive assessment of substance use patterns, withdrawal symptoms, and treatment response.

Common Clinical Scenarios

Patients undergoing detoxification who exhibit cognitive deficits.

Billing Considerations

Integration of behavioral therapies and monitoring for relapse.

Coding Guidelines

Inclusion Criteria

Use F13.26 When
  • According to ICD
  • 10 guidelines, F13
  • 26 should be used when there is clear evidence of dependence on sedatives, hypnotics, or anxiolytics, accompanied by a documented persisting amnestic disorder
  • Documentation must support the diagnosis and include details of the patient's substance use history and cognitive assessments

Exclusion Criteria

Do NOT use F13.26 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0031CPT Code

Mental health assessment

Clinical Scenario

Used when assessing cognitive function in patients with substance dependence.

Documentation Requirements

Detailed notes on cognitive assessments and substance use history.

Specialty Considerations

Psychiatric evaluations should include cognitive testing.

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 conditions like F13.26, which helps in better tracking and treatment planning for patients with complex needs.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including the differentiation of conditions like F13.26, which helps in better tracking and treatment planning for patients with complex needs.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including the differentiation of conditions like F13.26, which helps in better tracking and treatment planning for patients with complex needs.

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 the persisting amnestic disorder?

Documenting the persisting amnestic disorder is crucial as it directly impacts treatment planning and the understanding of the patient's cognitive deficits, which are essential for effective rehabilitation.