2025 ICD-10-CM code F55
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Mental, Behavioral and Neurodevelopmental disorders - Behavioral syndromes associated with physiological disturbances and physical factors Chapter V: Mental, Behavioral and Neurodevelopmental disorders Feed
Abuse of non-psychoactive substances.
Modifiers may be applicable depending on the circumstances of the encounter. For example, a modifier may be used to specify the place of service, the type of provider, or other relevant clinical information.
Medical necessity for treatment of non-psychoactive substance abuse is established when the excessive use of the non-psychoactive substance directly results in clinically significant symptoms and/or impairment of the patient's physical or psychological health.The diagnosis must be supported by clinical evidence.Treatment interventions must be appropriate to the severity of the condition.
The clinical responsibility for diagnosing and managing non-psychoactive substance abuse involves a thorough history taking, physical examination, and potentially laboratory investigations depending on the substance involved.Treatment planning may involve collaboration with other healthcare professionals, including behavioral health specialists.
- Chapter V: Mental, Behavioral and Neurodevelopmental disorders
- F50-F59 (Behavioral syndromes associated with physiological disturbances and physical factors)
In simple words: This code is for when someone uses too much of a substance that isn't a mind-altering drug, like taking too many laxatives or vitamins. It causes health problems and is diagnosed based on the person's symptoms, history, and a physical exam. Treatment depends on what was misused and how severe the problem is.
This code is used to classify the abuse of non-psychoactive substances.Non-psychoactive substance abuse refers to the excessive use of substances such as antacids, laxatives, hormones, vitamins, herbal supplements, and other substances that can interfere with bodily functions and affect health.The diagnosis is based on patient history, signs and symptoms, a detailed inquiry into personal and social behavior, and physical examination. Treatment may include rehydration, detoxification, behavioral therapy, counseling, and other interventions depending on the substance and severity of abuse.
Example 1: A patient presents with chronic diarrhea and abdominal pain due to excessive laxative use.The patient admits to using laxatives daily for weight loss.F55 is coded along with codes reflecting the resulting gastrointestinal symptoms., A patient is hospitalized for severe hypercalcemia secondary to excessive antacid intake. This patient has a history of chronic heartburn and self-medicated with over-the-counter antacids without consulting a doctor. F55 is coded to reflect the misuse of antacids, and additional codes are used to describe the hypercalcemia and its complications., A patient presents with symptoms of muscle weakness and fatigue due to prolonged self-administration of high doses of vitamin supplements. The patient reports taking large amounts of various supplements to improve energy levels. F55 is coded alongside codes that describe the patient's symptoms and laboratory findings (e.g., low potassium levels).
Detailed patient history including substance use patterns and duration, physical examination findings, and relevant laboratory results (e.g., electrolyte levels, hormone levels).In cases of hospitalization, documentation should include the details of hospital course, treatments provided, and response to treatment.
** Always review the most up-to-date ICD-10-CM coding guidelines and any payer-specific instructions for appropriate coding and billing practices.
- Payment Status: Active
- Modifier TC rule: Not applicable.F55 is a diagnosis code, not a procedure code.
- Specialties:Psychiatry, Internal Medicine, Family Medicine, Addiction Medicine
- Place of Service:Office, Hospital Inpatient, Hospital Outpatient, Emergency Room, Urgent Care Facility