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ICD-10 Guide
ICD-10 CodesF13.28

F13.28

Billable

Sedative, hypnotic or anxiolytic dependence with other sedative, hypnotic or anxiolytic-induced disorders

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

Code Description

ICD-10 F13.28 is a billable code used to indicate a diagnosis of sedative, hypnotic or anxiolytic dependence with other sedative, hypnotic or anxiolytic-induced disorders.

Key Diagnostic Point:

F13.28 refers to a condition characterized by a dependence on sedative, hypnotic, or anxiolytic substances, accompanied by other disorders induced by these substances. Patients with this diagnosis often exhibit a compulsive pattern of use, leading to significant impairment or distress. The dependence may manifest through withdrawal symptoms when the substance is reduced or discontinued, as well as tolerance, where increasing amounts are needed to achieve the desired effect. Additionally, individuals may experience cognitive impairments, mood disturbances, or other psychological issues as a result of their substance use. Treatment typically involves a combination of behavioral therapies, counseling, and, in some cases, pharmacotherapy to manage withdrawal symptoms and support recovery. Accurate diagnosis and coding are crucial for effective treatment planning and insurance reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between dependence and other substance use disorders
  • Identifying co-occurring mental health disorders
  • Documenting withdrawal symptoms accurately
  • Understanding the nuances of substance-induced disorders

Audit Risk Factors

  • Inadequate documentation of substance use history
  • Failure to document co-occurring disorders
  • Misclassification of withdrawal symptoms
  • Lack of evidence for treatment plans

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed patient history, including substance use patterns and mental health evaluations.

Common Clinical Scenarios

Patients presenting with anxiety disorders exacerbated by substance use.

Billing Considerations

Ensure comprehensive documentation of both substance use and mental health conditions for accurate coding.

Addiction Medicine

Documentation Requirements

Thorough assessment of substance use, including frequency, duration, and impact on daily functioning.

Common Clinical Scenarios

Patients undergoing detoxification or rehabilitation for sedative dependence.

Billing Considerations

Documenting the treatment plan and progress notes is crucial for ongoing care and coding accuracy.

Coding Guidelines

Inclusion Criteria

Use F13.28 When
  • According to ICD
  • 10 guidelines, F13
  • 28 should be used when there is clear evidence of dependence on sedatives, hypnotics, or anxiolytics, along with documented induced disorders
  • Coders must ensure that the documentation supports the diagnosis and reflects the complexity of the patient's condition

Exclusion Criteria

Do NOT use F13.28 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 sedative dependence.

Documentation Requirements

Comprehensive assessment notes detailing substance use history and mental health status.

Specialty Considerations

Psychiatric evaluations must include substance use history for accurate coding.

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 between dependence and other related conditions, which enhances treatment planning 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 between dependence and other related conditions, which enhances treatment planning 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 dependence and abuse in the context of F13.28?

Dependence involves a physical and psychological reliance on a substance, characterized by tolerance and withdrawal symptoms, while abuse refers to the harmful use of a substance without necessarily meeting the criteria for dependence.