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ICD-10 Guide
ICD-10 CodesF19.95

F19.95

Billable

Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder

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

Code Description

ICD-10 F19.95 is a billable code used to indicate a diagnosis of other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder.

Key Diagnostic Point:

F19.95 refers to a condition characterized by the use of unspecified psychoactive substances that lead to a psychotic disorder. This includes symptoms such as hallucinations, delusions, and disorganized thinking that arise during or shortly after the use of these substances. The diagnosis is made when the psychotic symptoms cannot be attributed to another mental disorder or medical condition. The individual may exhibit signs of substance use disorder, including cravings, withdrawal symptoms, and continued use despite negative consequences. Treatment often involves a combination of detoxification, psychotherapy, and medication management to address both the substance use and the psychotic symptoms. Clinicians must carefully assess the patient's substance use history and current mental state to provide appropriate care and support for recovery.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of psychoactive substances that can lead to similar symptoms
  • Need for comprehensive patient history to determine substance use
  • Differentiating between primary psychotic disorders and substance-induced disorders
  • Potential for co-occurring mental health conditions

Audit Risk Factors

  • Inadequate documentation of substance use history
  • Failure to specify the psychoactive substance involved
  • Misdiagnosis of primary psychotic disorders
  • Lack of evidence for the severity of symptoms

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with acute psychosis following substance use, or those with chronic substance use leading to psychotic symptoms.

Billing Considerations

Psychiatrists must differentiate between substance-induced symptoms and primary psychiatric disorders.

Addiction Medicine

Documentation Requirements

Comprehensive assessment of substance use, including types, amounts, and frequency of use.

Common Clinical Scenarios

Patients undergoing detoxification who exhibit psychotic symptoms.

Billing Considerations

Focus on the interplay between addiction and mental health, requiring thorough documentation of both aspects.

Coding Guidelines

Inclusion Criteria

Use F19.95 When
  • According to ICD
  • 10 guidelines, F19
  • 95 should be used when there is evidence of psychoactive substance use leading to psychotic symptoms, and no other mental disorder can explain the symptoms
  • Coders must ensure that documentation supports the diagnosis and includes details about the substance used

Exclusion Criteria

Do NOT use F19.95 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0031CPT Code

Mental health assessment

Clinical Scenario

Used when assessing a patient with suspected substance-induced psychosis.

Documentation Requirements

Detailed notes on the patient's mental state and substance use history.

Specialty Considerations

Psychiatrists and addiction specialists should ensure comprehensive assessments are documented.

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 and their complications, improving the ability to track and treat these conditions effectively. F19.95 provides a framework for identifying patients with complex needs related to substance use and mental health.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of substance use disorders and their complications, improving the ability to track and treat these conditions effectively. F19.95 provides a framework for identifying patients with complex needs related to substance use and mental health.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of substance use disorders and their complications, improving the ability to track and treat these conditions effectively. F19.95 provides a framework for identifying patients with complex needs related to substance use and mental health.

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 difference between F19.95 and other substance use disorder codes?

F19.95 specifically addresses cases where psychoactive substance use leads to psychotic symptoms, while other codes may focus on the substance use disorder itself without the psychotic component.