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ICD-10 Guide
ICD-10 CodesF19.951

F19.951

Billable

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

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

Code Description

ICD-10 F19.951 is a billable code used to indicate a diagnosis of other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with hallucinations.

Key Diagnostic Point:

F19.951 refers to a condition characterized by the use of unspecified psychoactive substances that leads to a psychotic disorder, specifically manifesting as hallucinations. This diagnosis is often seen in individuals who engage in the use of various substances, including but not limited to synthetic drugs, hallucinogens, or other non-specified psychoactive agents. The psychotic disorder is marked by significant alterations in perception, thought processes, and emotional responses, which can severely impact daily functioning. Patients may experience visual or auditory hallucinations, delusions, and disorganized thinking. The onset of these symptoms typically correlates with substance use, and the severity can vary based on the type and amount of substance consumed. Treatment often involves a combination of detoxification, psychiatric intervention, and rehabilitation programs aimed at addressing both the substance use disorder and the associated psychotic symptoms. Understanding the nuances of this diagnosis is crucial for effective treatment and management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Unspecified nature of the psychoactive substance complicates diagnosis.
  • Differentiating between substance-induced psychosis and primary psychotic disorders.
  • Need for comprehensive documentation of substance use history.
  • Potential for co-occurring mental health disorders.

Audit Risk Factors

  • Inadequate documentation of substance use history.
  • Failure to specify the type of psychoactive substance used.
  • Misdiagnosis of primary psychotic disorders instead of substance-induced.
  • Lack of evidence for the presence of hallucinations.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed psychiatric evaluation, including substance use history and mental status examination.

Common Clinical Scenarios

Patients presenting with acute psychosis following substance use, requiring hospitalization.

Billing Considerations

Documentation must clearly differentiate between substance-induced symptoms and underlying psychiatric conditions.

Addiction Medicine

Documentation Requirements

Comprehensive assessment of substance use patterns, withdrawal symptoms, and treatment history.

Common Clinical Scenarios

Patients undergoing detoxification who exhibit psychotic symptoms.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use F19.951 When
  • According to ICD
  • 10 coding guidelines, F19
  • 951 should be used when there is clear evidence of psychoactive substance use leading to psychotic symptoms, specifically hallucinations
  • Documentation must support the diagnosis, including the timeline of substance use and the onset of psychotic symptoms

Exclusion Criteria

Do NOT use F19.951 When
  • Exclusion criteria include primary psychotic disorders not related to substance use

Related ICD-10 Codes

Related CPT Codes

99214CPT Code

Established patient office visit, level 4

Clinical Scenario

Used when managing a patient with substance-induced psychosis in an outpatient setting.

Documentation Requirements

Document the patient's history, mental status examination, and treatment plan.

Specialty Considerations

Psychiatrists 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 precise coding of substance use disorders and their complications, such as psychotic disorders. 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 precise coding of substance use disorders and their complications, such as psychotic disorders. This specificity aids in better tracking of treatment outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more precise coding of substance use disorders and their complications, such as psychotic disorders. 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 is the difference between F19.951 and F19.920?

F19.951 includes the presence of psychotic symptoms, specifically hallucinations, while F19.920 refers to other psychoactive substance use without psychotic features.