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ICD-10 Guide
ICD-10 CodesChapter 5: Mental, Behavioral and Neurodevelopmental disordersF16

F16

Billable

Hallucinogen related disorders

Chapter 5:Mental, Behavioral and Neurodevelopmental disorders

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

Code Description

ICD-10 F16 is a billable code used to indicate a diagnosis of hallucinogen related disorders.

Key Diagnostic Point:

Hallucinogen related disorders encompass a range of conditions associated with the use of hallucinogenic substances, which can lead to significant alterations in perception, mood, and cognitive processes. These disorders include hallucinogen use disorder, hallucinogen intoxication, and hallucinogen withdrawal. Individuals may experience visual or auditory hallucinations, altered sense of time, and profound changes in thought processes. The use of hallucinogens can lead to psychological dependence, although physical dependence is less common. Treatment often involves behavioral therapies, counseling, and support groups, as well as addressing any co-occurring mental health disorders. Accurate diagnosis requires a thorough clinical assessment, including a detailed history of substance use and its impact on daily functioning. Clinicians must differentiate between hallucinogen-related disorders and other mental health conditions, such as schizophrenia or mood disorders, to ensure appropriate treatment and coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of hallucinogenic substances and their effects
  • Differentiation between intoxication, withdrawal, and use disorders
  • Potential co-occurring mental health conditions
  • Need for comprehensive patient history and documentation

Audit Risk Factors

  • Inadequate documentation of substance use history
  • Failure to specify the type of hallucinogen used
  • Misclassification of intoxication versus withdrawal
  • Lack of evidence for co-occurring mental health conditions

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with acute psychosis or mood disturbances following hallucinogen use.

Billing Considerations

Consideration of differential diagnoses such as schizophrenia or bipolar disorder.

Addiction Medicine

Documentation Requirements

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

Common Clinical Scenarios

Patients seeking treatment for hallucinogen dependence or experiencing withdrawal symptoms.

Billing Considerations

Integration of behavioral therapies and support systems in treatment planning.

Coding Guidelines

Inclusion Criteria

Use F16 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the specific hallucinogen involved and the nature of the disorder (intoxication, withdrawal, or use disorder)
  • Include any relevant co
  • occurring conditions for comprehensive coding

Exclusion Criteria

Do NOT use F16 When
No specific exclusions found.

Related CPT Codes

99214CPT Code

Established patient office visit, level 4

Clinical Scenario

Used for follow-up visits for patients with hallucinogen use disorder.

Documentation Requirements

Document the patient's history, current symptoms, and treatment plan.

Specialty Considerations

Psychiatric evaluations may require additional documentation of mental status and risk assessments.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of hallucinogen-related disorders, improving the ability to track and analyze these conditions in clinical settings. 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 hallucinogen-related disorders, improving the ability to track and analyze these conditions in clinical settings. 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 hallucinogen-related disorders, improving the ability to track and analyze these conditions in clinical settings. This specificity aids in better treatment planning and resource allocation.

Resources

Clinical References

  • •
    Substance Abuse and Mental Health Services Administration (SAMHSA)
  • •
    National Institute on Drug Abuse (NIDA)

Coding & Billing References

  • •
    Substance Abuse and Mental Health Services Administration (SAMHSA)
  • •
    National Institute on Drug Abuse (NIDA)

Frequently Asked Questions

What is the difference between hallucinogen intoxication and hallucinogen use disorder?

Hallucinogen intoxication refers to the acute effects experienced after using hallucinogens, including altered perceptions and mood changes. In contrast, hallucinogen use disorder is characterized by a pattern of problematic use leading to significant impairment or distress, including cravings and withdrawal symptoms.