Code Attributes
- Non-Billable/Non-Specific Code
Includes
- Ecstasy
- PCP
- Phencyclidine
Codes
- F16.1 Hallucinogen abuse
- F16.10 Hallucinogen abuse, uncomplicated
- F16.11 Hallucinogen abuse, in remission
- F16.12 Hallucinogen abuse with intoxication
- F16.120 Hallucinogen abuse with intoxication, uncomplicated
- F16.121 Hallucinogen abuse with intoxication with delirium
- F16.122 Hallucinogen abuse with intoxication with perceptual disturbance
- F16.129 Hallucinogen abuse with intoxication, unspecified
- F16.14 Hallucinogen abuse with hallucinogen-induced mood disorder
- F16.15 Hallucinogen abuse with hallucinogen-induced psychotic disorder
- F16.150 Hallucinogen abuse with hallucinogen-induced psychotic disorder with delusions
- F16.151 Hallucinogen abuse with hallucinogen-induced psychotic disorder with hallucinations
- F16.159 Hallucinogen abuse with hallucinogen-induced psychotic disorder, unspecified
- F16.18 Hallucinogen abuse with other hallucinogen-induced disorder
- F16.180 Hallucinogen abuse with hallucinogen-induced anxiety disorder
- F16.183 Hallucinogen abuse with hallucinogen persisting perception disorder (flashbacks)
- F16.188 Hallucinogen abuse with other hallucinogen-induced disorder
- F16.19 Hallucinogen abuse with unspecified hallucinogen-induced disorder
- F16.2 Hallucinogen dependence
- F16.20 Hallucinogen dependence, uncomplicated
- F16.21 Hallucinogen dependence, in remission
- F16.22 Hallucinogen dependence with intoxication
- F16.220 Hallucinogen dependence with intoxication, uncomplicated
- F16.221 Hallucinogen dependence with intoxication with delirium
- F16.229 Hallucinogen dependence with intoxication, unspecified
- F16.24 Hallucinogen dependence with hallucinogen-induced mood disorder
- F16.25 Hallucinogen dependence with hallucinogen-induced psychotic disorder
- F16.250 Hallucinogen dependence with hallucinogen-induced psychotic disorder with delusions
- F16.251 Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations
- F16.259 Hallucinogen dependence with hallucinogen-induced psychotic disorder, unspecified
- F16.28 Hallucinogen dependence with other hallucinogen-induced disorder
- F16.280 Hallucinogen dependence with hallucinogen-induced anxiety disorder
- F16.283 Hallucinogen dependence with hallucinogen persisting perception disorder (flashbacks)
- F16.288 Hallucinogen dependence with other hallucinogen-induced disorder
- F16.29 Hallucinogen dependence with unspecified hallucinogen-induced disorder
- F16.9 Hallucinogen use, unspecified
- F16.90 Hallucinogen use, unspecified, uncomplicated
- F16.91 Hallucinogen use, unspecified, in remission
- F16.92 Hallucinogen use, unspecified with intoxication
- F16.920 Hallucinogen use, unspecified with intoxication, uncomplicated
- F16.921 Hallucinogen use, unspecified with intoxication with delirium
- F16.929 Hallucinogen use, unspecified with intoxication, unspecified
- F16.94 Hallucinogen use, unspecified with hallucinogen-induced mood disorder
- F16.95 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder
- F16.950 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with delusions
- F16.951 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with hallucinations
- F16.959 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder, unspecified
- F16.98 Hallucinogen use, unspecified with other specified hallucinogen-induced disorder
- F16.980 Hallucinogen use, unspecified with hallucinogen-induced anxiety disorder
- F16.983 Hallucinogen use, unspecified with hallucinogen persisting perception disorder (flashbacks)
- F16.988 Hallucinogen use, unspecified with other hallucinogen-induced disorder
- F16.99 Hallucinogen use, unspecified with unspecified hallucinogen-induced disorder
ICD-10 Code F16 refers to disorders related to the abuse of hallucinogens. Understanding and correctly applying this code is essential for accurate billing and insurance claim processing for services provided to clients with hallucinogen use disorders.
Beyond administrative necessity, precise coding ensures appropriate treatment planning and facilitates meaningful clinical communication across interdisciplinary teams. It also contributes to reliable epidemiological data collection that informs public health initiatives and research on substance use disorders.
1. Diagnosis and documentation
When diagnosing a patient with a hallucinogen-related disorder, it's crucial to document their condition accurately. The ICD-10 offers several subdivisions within the F16 category, specifying the nature of the disorder.
Each of these codes provides a more detailed description of the patient's condition, which can significantly impact billing and insurance claims. Ensure that the diagnosis is thoroughly documented in the patient's record.
2. Billing and coding
When preparing to bill for services provided to a patient diagnosed with a hallucinogen use disorder, you'll need to enter the appropriate ICD-10 code (F16.x). This ensures that the billing information submitted to insurance companies is accurate, which is crucial for the reimbursement process.
Ensure accuracy
Double-check the diagnosis code for accuracy before submitting the claim. Incorrect codes can lead to claim rejections or denials.
Stay updated
ICD-10 codes can be updated annually, so it's important to verify that you're using the most current code. These updates may include new codes, revised descriptions, or changes in specificity requirements that directly impact reimbursement and clinical documentation standards.
3. Insurance claims
When filing insurance claims, the correct use of the F16 code is key. Here's what to keep in mind:
Pre-authorization
Some insurance plans may require pre-authorization for treatment of substance use disorders. Check the patient's benefits and plan requirements before beginning treatment.
Claim submission
Submit your claims electronically through your practice’s software or clearinghouse, making sure the F16 code and all supporting info are entered correctly. Verify that patient details, insurance information, and service descriptions match your notes before hitting send. Going electronic is generally faster than paper claims and gives you that helpful confirmation receipt for your records. Most systems have validation tools that catch common mistakes before submission, saving you from those frustrating denials. For those tricky cases with multiple diagnoses or unusual treatments, consider adding a brief explanation note when the claim format allows it, which can help justify medical necessity right from the start.
Follow up
After submitting a claim, keep an eye on its progress whenever you can. If a claim gets denied or rejected, take a good look at the explanation of benefits or remittance notice to see what went wrong. Quick follow-up not only keeps the money flowing but helps you spot patterns that might point to bigger problems in your billing process.
Sources
- "ICD-10 Code for Hallucinogen related disorders- F16- Codify by AAPC". Codify By AAPC. American Academy of Professional Coders, n.d., https://www.aapc.com/codes/icd-10-codes/F16?srsltid=AfmBOoqw6F_t53ufEIlLWBRu4X-tyiAaqKkXm2gQj6uJgo8hXbf9LnUu. Accessed 27 Jan 2025.
