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ICD-10 Guide
ICD-10 CodesF16.11

F16.11

Billable

Hallucinogen abuse, in remission

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

Code Description

ICD-10 F16.11 is a billable code used to indicate a diagnosis of hallucinogen abuse, in remission.

Key Diagnostic Point:

Hallucinogen abuse, in remission, refers to a condition where an individual has a history of hallucinogen use disorder but is currently not experiencing any symptoms of substance use or withdrawal. Hallucinogens, such as LSD, psilocybin, and mescaline, can lead to significant psychological dependence and alterations in perception, mood, and cognitive processes. The diagnosis of 'in remission' indicates that the individual has not engaged in hallucinogen use for a specified period, typically at least 12 months, and is not exhibiting any related symptoms. This status is crucial for treatment planning and monitoring, as individuals in remission may still face challenges related to cravings or psychological triggers. Treatment often involves counseling, support groups, and behavioral therapies aimed at maintaining sobriety and addressing underlying mental health issues. Clinicians must document the duration of remission and any ongoing treatment or support mechanisms in place to ensure accurate coding and appropriate care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between active use and remission status
  • Documenting the duration of remission accurately
  • Understanding the nuances of substance use disorder classifications
  • Identifying co-occurring mental health disorders

Audit Risk Factors

  • Inadequate documentation of remission duration
  • Failure to document ongoing treatment or support
  • Misclassification of active use versus remission
  • Lack of evidence for co-occurring mental health conditions

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Detailed history of substance use, treatment plans, and progress notes on remission status.

Common Clinical Scenarios

Patients transitioning from active use to remission, requiring ongoing support and monitoring.

Billing Considerations

Consideration of co-occurring disorders and the need for integrated treatment approaches.

Psychiatry

Documentation Requirements

Comprehensive mental health evaluations, including assessments of substance use history and current mental status.

Common Clinical Scenarios

Patients with a history of hallucinogen use presenting with anxiety or mood disorders.

Billing Considerations

Documentation of any therapeutic interventions aimed at preventing relapse.

Coding Guidelines

Inclusion Criteria

Use F16.11 When
  • According to ICD
  • 10 guidelines, F16
  • 11 should be used when a patient has a documented history of hallucinogen abuse but is currently in remission
  • Documentation must include the duration of remission and any ongoing treatment or support

Exclusion Criteria

Do NOT use F16.11 When
  • Exclusion criteria include active substance use or withdrawal symptoms

Related ICD-10 Codes

Related CPT Codes

H0031CPT Code

Mental health counseling

Clinical Scenario

Used for patients in therapy for hallucinogen abuse.

Documentation Requirements

Progress notes detailing the patient's history and treatment plan.

Specialty Considerations

Addiction specialists should document the focus on substance use and recovery.

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 distinction between active use and remission. This specificity aids in better tracking of treatment outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including the distinction between active use and remission. This specificity aids in better tracking of treatment outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including the distinction between active use and remission. This specificity aids in better tracking of treatment outcomes 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 does 'in remission' mean in the context of hallucinogen abuse?

In remission indicates that the individual has not used hallucinogens for a specified period, typically at least 12 months, and is not experiencing any withdrawal symptoms or related issues.