ICD‑10‑CM Coding for Steroid‑Induced Psychosis

Classification Framework

• Steroid‑induced psychosis is classified as a secondary (substance‑induced) psychotic disorder caused by drug‑related side effects or toxicity, and is placed within the ICD‑10‑CM substance‑induced psychotic disorder category. [American College of Radiology] 1, 2, 3

• The American College of Radiology guidelines explicitly list drug intoxication, withdrawal, side effects, and toxicity as medical conditions that can present with psychotic symptoms. 1, 2

Code Selection Based on Clinical Presentation

• F19.950 – assign when delusions are the predominant psychotic feature. 1, 2
• F19.951 – assign when hallucinations are the predominant psychotic feature. 1, 2
• F19.959 – assign when psychotic symptoms are present but neither delusions nor hallucinations clearly predominate. 1, 2

Clinical Features Distinguishing Psychosis from Delirium

• The cardinal psychotic features of steroid‑induced psychosis are delusions and hallucinations. 1, 2, 3
• Consciousness is preserved; patients retain awareness and level of consciousness, unlike delirium where consciousness fluctuates. 1, 2, 3
• Additional manifestations may include disorganized speech, abnormal motor behavior (e.g., agitation or catatonia), anger, hostility, insomnia, and paranoia. 1, 2

Coding Pitfalls and Recommendations

• Exclude delirium: Do not code steroid‑induced psychosis if the presentation is better explained by delirium (characterized by inattention and fluctuating consciousness). 1, 2, 4
• Avoid primary psychosis codes (F20‑F29) when corticosteroids are the clear precipitating factor; these codes are reserved for primary psychiatric disorders without a direct medical cause. 1, 2
• Do not use “unspecified psychosis” without documenting the substance‑induced etiology, as this obscures the reversible nature of the condition and its specific treatment needs. 1, 2