Quick reference
- When to use
- Use F22 when the client presents with psychotic symptoms consistent with Delusional Disorder. Ensure adequate duration criteria are met. Rule out substance-induced and medical causes before assigning a primary psychotic disorder code.
- Duration
- Schizophrenia: 6+ months continuous signs (1+ month active). Brief Psychotic Disorder: 1 day to 1 month. Schizoaffective: longitudinal course assessment needed. Document course specifiers.
- Session codes
- Pair with CPT 90834/90837 for therapy. Medication management: 99214/99215. 90853 for group skills training. 90785 for interactive complexity. Case management and ACT services may be warranted.
- Key indicators
- Delusions • Hallucinations • Disorganized speech • Grossly disorganized or catatonic behavior • Negative symptoms (flat affect, avolition) • Functional decline • Duration requirements vary by diagnosis
What F22 represents
Delusional disorder involves fixed, false beliefs that persist for at least one month. Functioning is generally preserved outside the delusional system, distinguishing it from schizophrenia.
Key diagnostic criteria
- One or more delusions for 1+ month
- Criterion A for schizophrenia never met (hallucinations, if present, are related to delusion)
- Functioning not markedly impaired apart from delusion impact
- Not attributable to substances or medical condition
Specify type: erotomanic, grandiose, jealous, persecutory, somatic, mixed, unspecified
Documentation essentials
Document the specific delusional content and type. Note preserved functioning outside the delusion. Specify bizarre vs. non-bizarre.
Differential diagnosis
Distinguish from schizophrenia, OCD with poor insight, body dysmorphic disorder, and somatic symptom disorder.
Treatment planning
Antipsychotics (limited evidence). CBT may help. Building therapeutic alliance is critical – don't directly challenge delusions initially.
Insurance & billing
Accepted code. Document the specific delusional type.
Updates & changes
DSM-5 no longer requires delusions to be non-bizarre.
Documentation pitfalls
Don't pathologize culturally normative beliefs. Ensure functioning assessment is thorough.
References
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).