Quick reference
- When to use
- Use F13.20 when the client meets criteria for Sedative, Hypnotic, or Anxiolytic Use Disorder, Moderate. Determine severity by symptom count: mild (2-3), moderate (4-5), severe (6+). Specify current status: in early remission, in sustained remission, or on maintenance therapy.
- Duration
- Early remission: 3-12 months without criteria met (except craving). Sustained remission: 12+ months. On maintenance therapy: receiving agonist medication. Tolerance/withdrawal don't count if on prescribed medication.
- Session codes
- Pair with CPT 90834/90837 for therapy. SBIRT: 99408/99409. Medication management: 99213/99214. Group therapy: 90853. Use 96127 for AUDIT/DAST screening. MAT visits may use specific E/M codes.
- Key indicators
- Impaired control over substance use • Social impairment • Risky use • Pharmacological indicators (tolerance, withdrawal) • Craving • Continued use despite problems • Giving up activities
What F13.20 represents
This covers misuse of benzodiazepines, sleeping pills, and other sedative-hypnotic medications. Given the widespread prescription of these medications, this is an increasingly important diagnosis.
Key diagnostic criteria
Standard 11-criteria substance use disorder framework applied to sedative/hypnotic/anxiolytic use, with 4-5 criteria met.
Documentation essentials
Document specific substances used, prescription vs. illicit use, criteria met, and withdrawal risks.
Differential diagnosis
Distinguish from appropriate medical use, alcohol use disorder (similar effects), and other sedative intoxication.
Treatment planning
Gradual taper under medical supervision. CBT for insomnia if benzodiazepines were used for sleep. Alternative anxiety management.
Insurance & billing
Accepted code. Document specific substance and severity.
Updates & changes
Increasing clinical attention due to prescription sedative misuse.
Documentation pitfalls
Withdrawal can be medically dangerous – always assess and plan for safe discontinuation.
References
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).