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ICD-10 Guide
ICD-10 CodesF13.951

F13.951

Billable

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

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

Code Description

ICD-10 F13.951 is a billable code used to indicate a diagnosis of sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations.

Key Diagnostic Point:

F13.951 refers to a condition characterized by the use of sedative, hypnotic, or anxiolytic substances that leads to a psychotic disorder with hallucinations. This diagnosis is often seen in individuals who misuse these substances, which can include benzodiazepines, barbiturates, and other sedatives. The psychotic disorder manifests as hallucinations, which can be auditory, visual, or tactile, and may significantly impair the individual's ability to function. The condition is classified as 'unspecified' when the specific substance used is not documented, making it crucial for healthcare providers to accurately record the type of substance involved. Treatment typically involves a combination of detoxification, psychiatric support, and rehabilitation programs aimed at addressing both the substance use disorder and the psychotic symptoms. Understanding the interplay between substance use and mental health is essential for effective management and recovery.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Unspecified nature of substance use complicates coding.
  • Requires detailed documentation of psychotic symptoms.
  • Differentiating between substance-induced and primary psychotic disorders.
  • Potential for co-occurring mental health disorders.

Audit Risk Factors

  • Inadequate documentation of substance use history.
  • Failure to specify the type of sedative or anxiolytic used.
  • Lack of evidence for psychotic symptoms in medical records.
  • Misclassification of substance-induced symptoms as primary disorders.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed psychiatric evaluations and treatment plans must be documented, including the nature of hallucinations and substance use history.

Common Clinical Scenarios

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

Billing Considerations

Psychiatrists must differentiate between substance-induced psychosis and other psychiatric disorders.

Addiction Medicine

Documentation Requirements

Comprehensive substance use assessments and treatment progress notes are essential.

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 strategies.

Coding Guidelines

Inclusion Criteria

Use F13.951 When
  • Follow the ICD
  • CM coding guidelines for substance use disorders, ensuring accurate documentation of the substance involved and the nature of the psychotic disorder
  • Include any relevant co
  • occurring conditions

Exclusion Criteria

Do NOT use F13.951 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 psychotic symptoms.

Documentation Requirements

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

Specialty Considerations

Psychiatrists should ensure comprehensive assessments are included.

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, improving the ability to capture the complexity of conditions like F13.951. 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, improving the ability to capture the complexity of conditions like F13.951. 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, improving the ability to capture the complexity of conditions like F13.951. 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 the 'unspecified' designation in F13.951?

The 'unspecified' designation indicates that the specific sedative, hypnotic, or anxiolytic used is not documented. This can complicate treatment and management, as different substances may have varying effects and withdrawal symptoms.