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ICD-10 Guide
ICD-10 CodesF16.94

F16.94

Billable

Hallucinogen use, unspecified with hallucinogen-induced mood disorder

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

Code Description

ICD-10 F16.94 is a billable code used to indicate a diagnosis of hallucinogen use, unspecified with hallucinogen-induced mood disorder.

Key Diagnostic Point:

F16.94 refers to a condition characterized by the use of hallucinogenic substances that leads to a mood disorder. Hallucinogens, such as LSD, psilocybin, and mescaline, can significantly alter perception, mood, and cognitive processes. When an individual uses these substances, they may experience various psychological effects, including hallucinations, altered reality, and mood disturbances. The mood disorder associated with hallucinogen use can manifest as depression, anxiety, or mood swings, which may require clinical intervention. The unspecified nature of the code indicates that the specific hallucinogen used is not documented, making it essential for healthcare providers to thoroughly assess the patient's substance use history. Treatment often involves a combination of psychotherapy, support groups, and, in some cases, pharmacotherapy to manage mood symptoms. Understanding the complexities of hallucinogen use and its psychological impact is crucial for effective treatment and recovery.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Unspecified nature of the hallucinogen complicates documentation.
  • Variability in mood disorder symptoms can lead to misdiagnosis.
  • Need for comprehensive substance use history for accurate coding.
  • Potential overlap with other substance use disorders.

Audit Risk Factors

  • Inadequate documentation linking mood disorder to hallucinogen use.
  • Failure to specify the hallucinogen used.
  • Inconsistent coding with clinical notes.
  • Lack of follow-up documentation on treatment outcomes.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed patient history, including substance use and mood symptoms.

Common Clinical Scenarios

Patients presenting with mood swings or depressive symptoms following hallucinogen use.

Billing Considerations

Consideration of co-occurring mental health disorders and substance use history.

Addiction Medicine

Documentation Requirements

Comprehensive assessment of substance use patterns and treatment history.

Common Clinical Scenarios

Patients in withdrawal or experiencing cravings for hallucinogens.

Billing Considerations

Integration of behavioral therapies and pharmacological interventions.

Coding Guidelines

Inclusion Criteria

Use F16.94 When
  • According to ICD
  • 10 guidelines, F16
  • 94 should be used when a patient has a documented history of hallucinogen use leading to mood disorder symptoms
  • It is essential to ensure that the mood disorder is directly linked to the substance use, and other potential causes are ruled out

Exclusion Criteria

Do NOT use F16.94 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

96150CPT Code

Health and behavior assessment

Clinical Scenario

Used when assessing the impact of hallucinogen use on mood.

Documentation Requirements

Document the assessment findings and treatment plan.

Specialty Considerations

Psychiatrists may use this code for comprehensive evaluations.

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 hallucinogens. F16.94 provides a framework for capturing the complexities of mood disorders associated with hallucinogen use, which was less detailed in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including hallucinogens. F16.94 provides a framework for capturing the complexities of mood disorders associated with hallucinogen use, which was less detailed in ICD-9.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including hallucinogens. F16.94 provides a framework for capturing the complexities of mood disorders associated with hallucinogen use, which was less detailed in ICD-9.

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 using F16.94?

F16.94 is significant as it captures the relationship between hallucinogen use and mood disorders, allowing for appropriate treatment and management of affected individuals.