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ICD-10 Guide
ICD-10 CodesChapter 5: Mental, Behavioral and Neurodevelopmental disordersF28

F28

Billable

Other psychotic disorder not due to a substance or known physiological condition

Chapter 5:Mental, Behavioral and Neurodevelopmental disorders

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

Code Description

ICD-10 F28 is a billable code used to indicate a diagnosis of other psychotic disorder not due to a substance or known physiological condition.

Key Diagnostic Point:

F28 encompasses a range of psychotic disorders that do not fall under the categories of schizophrenia spectrum disorders or are not attributable to substance use or identifiable physiological conditions. Patients with F28 may experience delusions, hallucinations, disorganized thinking, and other symptoms that significantly impair their social and occupational functioning. Unlike schizophrenia, which has specific diagnostic criteria, F28 serves as a catch-all for atypical presentations of psychosis. The etiology of these disorders can be multifactorial, including genetic, environmental, and psychosocial factors. Treatment typically involves antipsychotic medications, psychotherapy, and supportive interventions aimed at improving the patient's quality of life. Clinicians must conduct thorough assessments to differentiate F28 from other psychotic disorders, ensuring accurate diagnosis and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of symptoms that can overlap with other psychotic disorders.
  • Need for comprehensive clinical documentation to support diagnosis.
  • Potential for misdiagnosis with substance-induced psychosis.
  • Variability in treatment responses among patients.

Audit Risk Factors

  • Inadequate documentation of symptoms and their duration.
  • Failure to rule out substance-induced psychosis.
  • Lack of follow-up documentation on treatment response.
  • Misclassification of the disorder due to overlapping symptoms.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Comprehensive psychiatric evaluation, including history of present illness, mental status examination, and treatment plan.

Common Clinical Scenarios

Patients presenting with acute psychosis without clear etiology, or those with chronic symptoms that do not fit other diagnoses.

Billing Considerations

Documenting the absence of substance use and physiological conditions is crucial for accurate coding.

Neurology

Documentation Requirements

Neurological examination findings, imaging results, and differential diagnosis considerations.

Common Clinical Scenarios

Patients with psychotic symptoms that may have a neurological basis but do not meet criteria for known conditions.

Billing Considerations

Collaboration with psychiatry may be necessary to rule out other causes of psychosis.

Coding Guidelines

Inclusion Criteria

Use F28 When
  • According to ICD
  • 10 guidelines, F28 is used when psychotic symptoms are present but do not meet the criteria for schizophrenia or are not attributable to substance use or a known physiological condition
  • Documentation must clearly indicate the nature of the symptoms and the absence of other causes

Exclusion Criteria

Do NOT use F28 When
No specific exclusions found.

Related CPT Codes

90791CPT Code

Psychiatric diagnostic evaluation

Clinical Scenario

Used for initial assessment of patients suspected of having F28.

Documentation Requirements

Detailed history, mental status exam, and treatment recommendations.

Specialty Considerations

Psychiatrists should ensure comprehensive documentation to support the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of psychotic disorders, including F28, which helps in better tracking and management of these conditions. It emphasizes the need for detailed documentation to support the diagnosis.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of psychotic disorders, including F28, which helps in better tracking and management of these conditions. It emphasizes the need for detailed documentation to support the diagnosis.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of psychotic disorders, including F28, which helps in better tracking and management of these conditions. It emphasizes the need for detailed documentation to support the diagnosis.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the key symptoms of F28?

Key symptoms include delusions, hallucinations, disorganized thinking, and significant impairment in social or occupational functioning. These symptoms must not be attributable to substance use or a known medical condition.