ICD-10-CM Code for Alprazolam (Xanax) Abuse
The ICD-10-CM code for alprazolam abuse is F13.10 (Sedative, hypnotic, or anxiolytic use disorder, mild) or F13.1 (Sedative, hypnotic, or anxiolytic abuse).
Understanding the Coding Structure
- Alprazolam is classified as a benzodiazepine, which falls under the sedative, hypnotic, or anxiolytic drug category in ICD-10-CM coding 1
- The F13 category encompasses all sedative, hypnotic, or anxiolytic-related disorders, including benzodiazepines like alprazolam 2
- The fourth character distinguishes between abuse (.1) and dependence (.2), with abuse representing a less severe pattern of problematic use 3
Specific Code Selection Algorithm
Use F13.10 when the patient meets criteria for mild sedative use disorder or abuse pattern without physiological dependence features 3
Use F13.20 (Sedative, hypnotic, or anxiolytic dependence, uncomplicated) when the patient demonstrates:
- Tolerance requiring dose escalation beyond prescribed amounts 2, 3
- Withdrawal symptoms upon discontinuation 2, 3
- Loss of control over use despite attempts to cut down 4
- Continued use despite knowledge of physical or psychological harm 5
Use F13.23 when active intoxication is present at the time of encounter 5
Clinical Context for Accurate Coding
- Alprazolam has particularly high misuse liability compared to other benzodiazepines due to its rapid absorption, quick brain penetration, and reinforcing properties 2, 3
- The median therapeutic concentration is 0.08 mg/L, but concentrations ≥0.1 mg/L are associated with increased toxicity risk, particularly when combined with other substances 5
- In 94.9% of alprazolam-related deaths, other drugs were present, most commonly opioids (64.6%), other benzodiazepines (44.4%), and alcohol (34.5%), indicating polysubstance use patterns 5
Common Coding Pitfalls to Avoid
- Do not code as F13.9 (unspecified) when sufficient clinical information exists to determine abuse versus dependence—this represents inadequate documentation 3
- Distinguish between prescribed long-term use for legitimate anxiety/panic disorder (which may show physiological dependence but not abuse) versus misuse patterns characterized by dose escalation, doctor shopping, or non-medical use 4
- Patients using alprazolam "as required" rather than as prescribed, even at therapeutic doses, may represent controlled self-medication of underlying psychopathology rather than abuse, requiring careful clinical judgment 4
- Add fifth character to specify current clinical status: .10 (mild), .20 (moderate/severe uncomplicated), .21 (in remission), .23 (with intoxication) 5, 3