What is ICD-10 code F10.159?

F10.159 is the ICD-10-CM diagnosis code for Alcohol abuse with alcohol-induced psychotic disorder, unspecified. A person who abuses alcohol and experiences psychotic symptoms (such as delusions or hallucinations) from alcohol use, but the specific type of psychotic symptom is not documented. F10.159 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F10.159 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F10.159 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F10.159 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does F10.159 map to under V28?

F10.159 maps to CMS-HCC V28 HCC 136 (Alcohol Use with Psychotic Complications). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM F10.159: Alcohol abuse

F10.159 maps to CMS-HCC V28 136. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupF10.159Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)

F10.159

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Alcohol abuse with alcohol-induced psychotic disorder, unspecified

A person who abuses alcohol and experiences psychotic symptoms (such as delusions or hallucinations) from alcohol use, but the specific type of psychotic symptom is not documented.

Buddy Insight

This code captures alcohol abuse with alcohol-induced psychotic disorder, unspecified, documenting a psychiatric manifestation directly caused by alcohol use.

CMS-HCC V28

Mapped

HCC 136

Alcohol Use with Psychotic Co...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 083

HHS-HCC 083 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 54

Substance Use with Psychotic ...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F10.1Alcohol abuse

F10.15Alcohol abuse with alcohol-induced psychotic disorder

F10.159Alcohol abuse with alcohol-induced psychotic disorder, unspecified

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F10.159 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F10.159 in this effective period.

Related Child Codes

Official

F10.150Alcohol abuse with alcohol-induced psychotic disorder with delusions

F10.151Alcohol abuse with alcohol-induced psychotic disorder with hallucinations

Includes

Official

ICD-10-CM does not list Includes notes for F10.159 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F10.159 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F10.159 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F10.159 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F10.159 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of a maladaptive pattern of alcohol use with clinically significant impairment or distress (recurrent use causing role failure, hazardous use, legal problems, or social/interpersonal problems)

Confirmation that criteria for alcohol dependence are NOT met (no tolerance, withdrawal, or compulsive use pattern)

Documentation that the psychotic disorder, unspecified is directly attributable to alcohol use, not a primary/independent psychiatric disorder

Documentation of psychotic symptoms (delusions and/or hallucinations) and their temporal relationship to alcohol use

MEAT Support

HCC Buddy guidance

Confirmation that criteria for alcohol dependence are NOT met (no tolerance, withdrawal, or compulsive use pattern)

Documentation that the psychotic disorder, unspecified is directly attributable to alcohol use, not a primary/independent psychiatric disorder

Documentation of psychotic symptoms (delusions and/or hallucinations) and their temporal relationship to alcohol use

Audit Caution

HCC Buddy guidance

Coding alcohol abuse when documentation actually supports dependence (tolerance, withdrawal, compulsive use) — always use the highest severity level documented

Assigning an alcohol use disorder code based solely on lab values (elevated GGT, MCV) without provider documentation of the clinical diagnosis

Coding a primary psychiatric disorder separately when the condition is substance-induced — the combination code captures both the substance use and the psychiatric manifestation

Failing to establish the temporal relationship between alcohol use and psychiatric symptoms — substance-induced conditions onset during or shortly after intoxication/withdrawal

Common Mistakes

HCC Buddy guidance

F10.2x — Alcohol dependence codes; dependence is a more severe pattern with tolerance/withdrawal/compulsive use — verify provider intent

F10.9x — Alcohol use, unspecified; less specific — always code to the highest documented specificity (abuse > unspecified)

F20.x — Schizophrenia spectrum disorders; primary psychotic disorders are independent of substance use — verify temporal relationship to alcohol

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is F10.159 an HCC code?

Yes. F10.159 (Alcohol abuse with alcohol-induced psychotic disorder, unspecified) maps to HCC 136, Alcohol Use with Psychotic Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.424. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: F10.159 is billable and maps to V28 HCC 136, Alcohol Use with Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F10.159
Description: Alcohol abuse with alcohol-induced psychotic disorder, unspecified
HCC (V28): HCC 136 — Alcohol Use with Psychotic Complications
RAF reference coefficient: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 136, Alcohol Use with Psychotic Complications

0.424

ESRDHCC 54, Substance Use with Psychotic Complications

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work F10.159 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for F10.159

For F10.159 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed F10.159 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F10.159 is the ICD-10-CM diagnosis code for alcohol abuse with alcohol-induced psychotic disorder, unspecified. A person who abuses alcohol and experiences psychotic symptoms (such as delusions or hallucinations) from alcohol use, but the specific type of psychotic symptom is not documented. F10.159 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering mental and behavioral disorders due to psychoactive substance use (f10-f19).

Under the CMS-HCC V28 risk adjustment model, F10.159 maps to Alcohol Use with Psychotic Complications (HCC 136) with a source-labeled community, non-dual, aged reference coefficient of 0.424. No V24 mapping is shown for F10.159; use the applicable model and payment year when reviewing the V28 mapping. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Use this code when psychotic disorder is present but hallucinations are not specifically documented. Because F10.159 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for F10.159 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use this code when psychotic disorder is present but hallucinations are not specifically documented
•Query the provider if hallucinations are present, as F10.151 would be more specific

Clinical Significance

This code captures alcohol abuse with alcohol-induced psychotic disorder, unspecified, documenting a psychiatric manifestation directly caused by alcohol use. The distinction between substance-induced psychiatric symptoms and primary psychiatric disorders is clinically crucial for treatment planning — substance-induced conditions may resolve with sustained sobriety. These combination codes carry higher risk adjustment weight reflecting the dual complexity of substance use disorder combined with psychiatric comorbidity.

Documentation Requirements

✓Documentation of a maladaptive pattern of alcohol use with clinically significant impairment or distress (recurrent use causing role failure, hazardous use, legal problems, or social/interpersonal problems)
✓Confirmation that criteria for alcohol dependence are NOT met (no tolerance, withdrawal, or compulsive use pattern)
✓Documentation that the psychotic disorder, unspecified is directly attributable to alcohol use, not a primary/independent psychiatric disorder
✓Documentation of psychotic symptoms (delusions and/or hallucinations) and their temporal relationship to alcohol use
✓Assessment and plan addressing alcohol use disorder with treatment recommendations (counseling, medication-assisted treatment, referral, etc.)

Commonly Confused Codes

•F10.2x: Alcohol dependence codes; dependence is a more severe pattern with tolerance/withdrawal/compulsive use: verify provider intent
•F10.9x: Alcohol use, unspecified; less specific: always code to the highest documented specificity (abuse > unspecified)
•F20.x: Schizophrenia spectrum disorders; primary psychotic disorders are independent of substance use: verify temporal relationship to alcohol