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F06.0

Billable

Psychotic disorder with hallucinations due to known physiological condition

This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).

What This Code Means

Hallucinations or false perceptions caused by a known medical condition, such as infection, neurological disease, or metabolic disorder, rather than a primary psychiatric illness.

Coding Tips

  • Clearly document the underlying physiological condition responsible for the psychotic symptoms
  • Distinguish from primary psychotic disorders by confirming the medical cause is documented

Excludes 2 — Not included here, may code separately

  • hallucinations and perceptual disturbance induced by alcohol and other psychoactive substances (F10-F19 with .151, .251, .951)
  • schizophrenia (F20.-)

Code Hierarchy

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