ICD-10 Coding for Psychosis(F29, F20.9, F25.9)
Complete ICD-10-CM coding and documentation guide for Psychosis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Psychosis
F20-F29Primary Range
Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders
This range includes primary codes for various forms of psychosis, including schizophrenia and schizoaffective disorders.
Psychotic disorder with delusions due to known physiological condition
Used when psychosis is due to a physiological condition, such as Parkinson's disease.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| F29 | Unspecified psychosis not due to a substance or known physiological condition | Use when psychosis is present without a specific diagnosis or known cause. |
|
| F20.9 | Schizophrenia, unspecified | Use for chronic psychosis with schizophrenia symptoms but unspecified subtype. |
|
| F25.9 | Schizoaffective disorder, unspecified | Use when both mood disorder and psychotic symptoms are present. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for unspecified psychosis
Essential facts and insights about Psychosis
Primary ICD-10-CM Codes for psychosis
Decision Criteria
clinical Criteria
- No specific psychotic disorder diagnosis available.
Applicable To
- Psychosis NOS
Excludes
- Substance-induced psychosis
- Psychotic disorder due to known physiological condition
Clinical Validation Requirements
- Absence of substance use or medical etiology documented
Code-Specific Risks
- Risk of under-coding if more specific diagnosis is available.
Coding Notes
- Ensure thorough documentation to avoid unspecified coding.
F20.9 - Schizophrenia, unspecified
Use for chronic psychosis with schizophrenia symptoms but unspecified subtype.
Applicable To
- Schizophrenia NOS
Excludes
- Schizoaffective disorder
Clinical Validation Requirements
- Symptoms present for at least 6 months, including delusions or hallucinations.
Coding Notes
Document duration and specific symptoms to support diagnosis.
F25.9 - Schizoaffective disorder, unspecified
Use when both mood disorder and psychotic symptoms are present.
Applicable To
- Schizoaffective disorder NOS
Excludes
- Bipolar disorder with psychotic features
Clinical Validation Requirements
- Concurrent mood disorder and psychotic symptoms.
Coding Notes
Ensure mood disorder is documented alongside psychosis.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Psychosis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F29.
Impact
Clinical: May lead to misdiagnosis and inappropriate treatment., Regulatory: Potential for audit failure due to non-compliance., Financial: Reduced reimbursement due to unspecified coding.
Mitigation Strategy
Ensure detailed documentation of symptoms., Regular training on coding updates.
Impact
Reimbursement: May lead to incorrect DRG assignment and lower reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data affecting clinical outcomes and research.
Mitigation Strategy
Use specific codes for substance-induced psychosis such as F10.259 for alcohol-induced.
Impact
High risk of audit if using unspecified codes without supporting documentation.
Mitigation Strategy
Ensure documentation includes specific symptoms and excludes other causes.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Psychosis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Psychosis
Use these documentation templates to ensure complete and accurate documentation for Psychosis. These templates include all required elements for proper coding and billing.
Acute psychosis evaluation
Specialty: PsychiatryRequired Elements
- Onset and duration of symptoms
- Presence of hallucinations or delusions
- Substance use history
- Medical history and physical exam findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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