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ICD-10 Guide
ICD-10 CodesF16.21

F16.21

Billable

Hallucinogen dependence, in remission

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

Code Description

ICD-10 F16.21 is a billable code used to indicate a diagnosis of hallucinogen dependence, in remission.

Key Diagnostic Point:

Hallucinogen dependence, in remission, refers to a state where an individual has previously met the criteria for hallucinogen dependence but is currently not experiencing the symptoms associated with the disorder. Hallucinogens, such as LSD, psilocybin, and mescaline, can lead to significant psychological dependence characterized by a strong desire to use the substance, tolerance, and withdrawal symptoms. 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 withdrawal symptoms or cravings. This condition is crucial to identify in treatment settings, as it helps healthcare providers tailor interventions and support for individuals recovering from substance use disorders. Treatment may involve counseling, support groups, and behavioral therapies aimed at preventing relapse and promoting long-term recovery. Accurate coding is essential for appropriate treatment planning and insurance reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between active dependence and remission status
  • Understanding the specific hallucinogens involved
  • Documenting the duration of remission accurately
  • Identifying co-occurring mental health disorders

Audit Risk Factors

  • Inadequate documentation of remission duration
  • Failure to specify the type of hallucinogen used
  • Misclassification of active dependence versus remission
  • Lack of evidence for treatment interventions

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Detailed history of substance use, treatment history, and current status of remission.

Common Clinical Scenarios

Patients presenting for follow-up after treatment for hallucinogen dependence.

Billing Considerations

Ensure clear documentation of remission status and any ongoing support or therapy.

Psychiatry

Documentation Requirements

Comprehensive mental health assessment, including any co-occurring disorders.

Common Clinical Scenarios

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

Billing Considerations

Document any psychiatric evaluations and treatment plans that address both substance use and mental health.

Coding Guidelines

Inclusion Criteria

Use F16.21 When
  • According to ICD
  • 10 guidelines, F16
  • 21 should be used when the patient has a documented history of hallucinogen dependence but is currently in remission
  • It is essential to ensure that the remission status is clearly documented, and any relevant treatment or support services are noted

Exclusion Criteria

Do NOT use F16.21 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0001CPT Code

Behavioral health assessment

Clinical Scenario

Used during initial evaluations for patients with a history of hallucinogen use.

Documentation Requirements

Comprehensive assessment of substance use history and current status.

Specialty Considerations

Addiction specialists should ensure thorough documentation of all relevant factors.

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 hallucinogen dependence. This specificity aids in better tracking of treatment outcomes and resource allocation for addiction services.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including hallucinogen dependence. This specificity aids in better tracking of treatment outcomes and resource allocation for addiction services.

Reimbursement & Billing Impact

reimbursement.

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 dependence?

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