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ICD-10 Guide
ICD-10 CodesF16.98

F16.98

Billable

Hallucinogen use, unspecified with other specified hallucinogen-induced disorder

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

Code Description

ICD-10 F16.98 is a billable code used to indicate a diagnosis of hallucinogen use, unspecified with other specified hallucinogen-induced disorder.

Key Diagnostic Point:

F16.98 refers to a condition characterized by the use of hallucinogenic substances that lead to various psychological and physiological effects. Hallucinogens, such as LSD, psilocybin, and mescaline, can induce altered states of consciousness, perceptual distortions, and significant changes in mood and thought processes. The unspecified nature of this code indicates that the specific hallucinogen used is not documented, but the patient exhibits symptoms consistent with hallucinogen-induced disorders. These can include hallucinations, delusions, and significant impairment in social or occupational functioning. Treatment often involves supportive care, psychotherapy, and in some cases, pharmacotherapy to manage acute symptoms or withdrawal. Understanding the nuances of hallucinogen use and its impact on mental health is crucial for effective treatment and coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in symptoms and severity of hallucinogen-induced disorders
  • Need for precise documentation of substance use history
  • Differentiation from other substance use disorders
  • Potential for co-occurring mental health conditions

Audit Risk Factors

  • Inadequate documentation of substance use history
  • Failure to specify the hallucinogen used
  • Lack of evidence for the diagnosis of hallucinogen-induced disorder
  • Inconsistent coding of co-occurring mental health conditions

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

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

Common Clinical Scenarios

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

Billing Considerations

Consideration of underlying mental health disorders and the need for a comprehensive treatment plan.

Addiction Medicine

Documentation Requirements

Thorough assessment of substance use patterns and treatment history.

Common Clinical Scenarios

Patients in withdrawal or seeking treatment for hallucinogen use disorder.

Billing Considerations

Integration of behavioral therapies and support systems in treatment planning.

Coding Guidelines

Inclusion Criteria

Use F16.98 When
  • Follow the ICD
  • CM coding guidelines for substance use disorders, ensuring accurate documentation of the patient's substance use history and current symptoms
  • Include any co
  • occurring mental health diagnoses as appropriate

Exclusion Criteria

Do NOT use F16.98 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0031CPT Code

Mental health assessment

Clinical Scenario

Used when assessing a patient for hallucinogen use disorder.

Documentation Requirements

Comprehensive assessment notes detailing substance use history and current symptoms.

Specialty Considerations

Psychiatric evaluations should include a thorough review of mental health history.

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 treat these conditions effectively.

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 treat these conditions effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of hallucinogen-related disorders, improving the ability to track and treat these conditions effectively.

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 are the common hallucinogens associated with F16.98?

Common hallucinogens include LSD, psilocybin mushrooms, mescaline, and DMT. Each can lead to unique symptoms and treatment considerations.