What ICD-10 Code is for Pathological Gambling?

The ICD-10 code for pathological gambling is F63.0. This code is found in the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (IDC-10). This is the system physicians and mental health providers use to code and classify diagnoses for claims processing. In addition, according to the CDC, the ICD-10 helps promote international comparability with the presentation, classification, processing, and collection of data. Revisions to the codes are periodically made to incorporate changes that have occurred in the healthcare industry.

The Importance of ICD-10 Codes

The ICD-10 provides a worldwide format for reporting health and mental issues and translating them into universal medical codes. This is accomplished using the selection rules, modification rules, and classification structure from the applicable ICD revision published by the World Health Organization

In 2009, the US Department of Health and Human Services issued a final ruling mandating that everyone covered by the Health Insurance Portability and Accountability Act, or HIPAA, is required to implement ICD-10 for medical coding. In addition, according to the American Psychological Association, psychologists and therapists should use ICD-10 codes when assessing or treating individuals as of October 1, 2015. The newer version provides more specific details for the assessment and diagnoses of clients than the ICD-9.

Only billable services utilizing ICD-10 codes are processed for payment by Medicare and most other forms of insurance. In addition, all services provided for mental disorders or substance abuse are subject to HIPAA standards. The Diagnostic and Statistical Manual of Mental Health Disorders-5, or DSM-5, includes the ICD-10 codes for substance use and mental disorders. Behavioral health providers, clinicians, and other service providers are expected to be trained in using ICD-10 codes.

Pathological Gambling

Most of the ICD-10 codes for mental, behavioral, and neurodevelopmental health disorders are organized in clusters under the F codes. The F60-F69 cluster covers disorders of adult personality and behavior, the G codes include mental health issues related to the nervous system, and the Z codes contain mental health factors influencing health status.

Under the ICD-10, the F63 code classifies habit and impulse disorders, excluding the habitual excessive use of psychoactive substances or alcohol and impulse disorders involving sexual behavior. The ICD-10 code for pathological gambling, F63.0, also includes compulsive gambling and gambling disorder.

According to the WHO, ICD-10 F63.0 defines pathological gambling as a disorder consisting of frequent, repeated episodes of gambling dominating a person’s life to the detriment of material, occupational, social and family values and commitments. The F63.0 pathological gambling code excludes gambling and betting related to lifestyle under Z72.6, excessive gambling by manic clients under F30 and F31, and gambling in antisocial, dissocial personality disorder under F60.2.

History of DSM Classification of Problematic Gambling

There have been several updates to the Diagnostic and Statistical Manual of Mental Health Disorders regarding problematic gambling. This history is important because the  latest criteria for assessment and diagnosis build on prior versions. The changes made to the DSM also reflect how the thinking about the disorder has evolved to treat the condition more like a substance use disorder, which has implications for therapy. 

DSM-IV: Pathological Gambling

The DSM-IV requires persistent and recurrent maladaptive gambling to be indicated by no less than five of the 10 potential criteria. The DSM-IV criteria for pathological gambling include:

  • A preoccupation with gambling
  • Needing to gamble in increasing amounts for the same level of excitement
  • Repeated unsuccessful efforts to control or stymie gambling
  • Suffering from restlessness or irritability when attempting to stop or cut down on gambling
  • Gambling to escape problems or negative emotions
  • Returning to the same gambling activity in an effort to recoup their losses
  • Lying to loved ones to conceal their level of involvement with gambling
  • Committing illegal acts to finance gambling
  • Jeopardizing relationships, jobs, or career opportunities due to gambling
  • Relying on others to provide money for relief from desperate financial situations caused by gambling

DSM-5: Gambling Disorder

The DSM-5 replaced pathological gambling from the DSM-IV with gambling disorder. The new gambling disorder classification dropped the illegal acts criterion from the earlier version. It also only requires four criteria rather than five and clarifies that they must occur within the last 12 months for diagnosis. 

In addition, the updated DSM-5 from 2013 reclassified the renamed gambling disorder as an addictive disorder rather than an impulse control disorder. The change was made to improve clarity for assessment, diagnosis, and treatment. It also was intended to increase recognition and improve research efforts into gambling disorders. In addition, the change was also a reflection of the similarities between substance addiction and problem gambling. 

Treatment for Gambling Disorder

The DSM-5 criteria establish a standardized framework to help practitioners better identify and diagnose gambling disorders. More accurate diagnoses provide more appropriate treatment and intervention planning options for overcoming the challenges involved with having a gambling disorder.

According to the American Psychiatric Association, gambling disorders have a detrimental effect on the person engaging in the activity and their families. A person with the condition may have periods when symptoms subside. These breaks from gambling activities may give the impression to people around them and mental health professionals that they are embracing a healthier lifestyle, which is often not the case.

Risk factors for the disorder include social inequity and trauma, especially among women. Men tend to develop this disorder earlier in life, and women typically develop the disorder later in life. In addition, family history plays a role in a person developing a gambling issue. 

Only 10% of the individuals with a gambling disorder actually seek treatment. It is also worth noting that gambling disorders are associated with an increased risk of suicide.

Currently, no FDA-approved prescriptions are available to treat gambling disorders. There are medications available that can help treat co-current conditions like anxiety or depression.

Therapy for Gambling Disorder

The most common types of therapy used to treat gambling disorders include cognitive behavioral therapy and psychodynamic therapy. Counseling aims to help clients understand more about their gambling behavior and how it affects them as individuals and their families. Therapy can also help them identify and change behaviors and thoughts that contribute to problem gambling.

Additionally, therapy for gambling disorders may help people heal family relationships and gain control over gambling habits and urges. Sessions with a mental health professional can also improve how clients manage stress, allocate their free time, and develop a plan to get their finances back in order. Once a person has refrained from gambling for a significant duration, counseling can help the person maintain their journey to recovery and avoid potential triggers that may cause a relapse. 

Support Groups

Support groups like Gamblers Anonymous can be helpful for individuals with gambling disorders in conjunction with therapy. Gamblers Anonymous is modeled on Alcoholics Anonymous and is a mutual-help group. The only requirement to attend is a desire to stop gambling, and there is no fee to participate. At meetings, people can share their experiences, learn from others, and find support for their recovery from gambling disorder.

Coping With Cravings

Individuals with a gambling disorder typically need strategies to deal with the persistent cravings they experience. They should be encouraged to reach out to others for support. Close friends or family members are typically some of the best people to turn to when these clients are feeling low. Clients also benefit from finding different ways to distract themselves with other activities like exercise. Postponing gambling activities is an effective strategy. Oftentimes, people just need time to allow the urge to weaken or pass on.

Family and Loved Ones

Partners, family members, and friends may be crucial for those struggling with a gambling disorder who have entered therapy. During family therapy for gambling disorder, loved ones should be encouraged to be honest about how the person’s gambling is affecting their lives. However, it is important that they make an effort to recognize the positive qualities of the person with the disorder during treatment.

Therapists also may want to advise loved ones not to bail out the gambler because by doing so, they are enabling the behavior. At the same time, excluding the gambler from life and family activities is ill-advised. Once a person enters therapy, they will need support and patience. Family members must understand that it is unreasonable to expect an immediate recovery from a gambling disorder. There will most likely be instances of relapses during a loved one’s recovery journey.

Documentation With AutoNotes

Mental health issues like gambling disorders are complex. AutoNotes allows you to easily document sessions with your clients and the treatment strategies used no matter how complicated the mental health issue. 

The AutoNotes process starts with AI clinical documentation templates. These can be used for individual or family sessions. The templates feature a streamlined approach to psychotherapy and behavioral management powered by smarter AI templates designed to optimize client care and clinical documentation. AutoNotes helps you quickly summarize the session with objectives, evidence, and strategies used, along with the appropriate ICD-10 diagnosis. This allows you to spend less time on paperwork and more time with clients.

The summaries produced by AutoNotes allow you to include secondary and tertiary ICD-10 diagnoses, if applicable, to help make the progress notes more informative and personalized. In addition, the system protects your client’s privacy by storing all data on a HIPAA-compliant Google Cloud Platform and protecting your connections to this server with Cloudflare. For an added layer of security, AutoNotes deidentifies personal health information to protect you and your clients.

AutoNotes is trusted by over 8,000 clinicians because our company is dedicated to listening to therapists and providing the tools they need to improve client care. Check out our AutoNotes Community page to learn more.

Say Goodbye to Manual Notes with AutoNotes