F13.259

Billable

Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified

HCC Category Mapping

V28HCC 135 — Drug/Alcohol Psychosis

0.000

V24HCC 54 — Drug/Alcohol Psychosis

0.434

ESRDHCC 54 — Drug/Alcohol Psychosis

0.000

What This Code Means

A person is dependent on sedatives, sleeping pills, or anti-anxiety medications and is experiencing psychotic symptoms caused by these drugs, but the specific type of psychotic symptom is not specified.

Coding Tips

•Use this code only when the documentation does not clearly specify whether delusions or hallucinations are present
•Query the provider if possible to obtain more specific documentation for F13.250 or F13.251

Clinical Significance

This code captures sedative dependence with psychotic disorder where the specific psychotic symptom type is not specified. While it still maps to the highest substance use HCC category, it represents a documentation improvement opportunity. The provider has identified psychotic symptoms but not clarified whether delusions, hallucinations, or both are present.

Documentation Requirements

✓Documentation of sedative, hypnotic, or anxiolytic dependence
✓Evidence of substance-induced psychotic symptoms without specification of type
✓Clinical assessment confirming substance-induced rather than primary psychosis
✓Timeline of substance use and psychotic symptom onset
✓Note indicating why specific psychotic symptom type could not be determined

Commonly Confused Codes

F13.250 — Use when delusions are specifically documented F13.251 — Use when hallucinations are specifically documented F13.29 — Unspecified induced disorder; broader category, not specific to psychosis F13.159 — Sedative ABUSE with unspecified psychotic disorder; less severe use pattern F13.959 — Unspecified sedative use with unspecified psychotic disorder; use when dependence is not confirmed

Code Hierarchy

└F13Sedative, hypnotic, or anxiolytic related disorders └F13.2Sedative, hypnotic or anxiolytic-related dependence └F13.25Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder └F13.259Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified

└F13.259Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified