F10.251
BillableAlcohol dependence with alcohol-induced psychotic disorder with hallucinations
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F10.251 an HCC code?
Yes. F10.251 maps to Alcohol Use with Psychotic Complications under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Psychosis under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for F10.251
For F10.251 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 F10.251 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F10.251 is the ICD-10-CM diagnosis code for alcohol dependence with alcohol-induced psychotic disorder with hallucinations. A person who is dependent on alcohol and is experiencing hallucinations (seeing or hearing things that aren't real) as a result of alcohol-induced psychosis. F10.251 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, F10.251 maps to Alcohol Use with Psychotic Complications (HCC 136) with a community, non-dual, aged base RAF weight of 0.275. Under the older CMS-HCC V24 model, F10.251 maps to Drug/Alcohol Psychosis (HCC 54) with a community, non-dual, aged base RAF weight of 0.434. 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.
Document the specific type of hallucinations (auditory, visual, tactile) when possible. Because F10.251 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, and MEAT documentation criteria for F10.251 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific type of hallucinations (auditory, visual, tactile) when possible
- •Distinguish between hallucinations during intoxication versus withdrawal versus chronic alcohol-induced psychosis
Clinical Significance
This code captures alcohol dependence with alcohol-induced psychotic disorder with hallucinations, 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 alcohol dependence with at least three of: tolerance, withdrawal, use in larger amounts/longer periods than intended, persistent desire or unsuccessful efforts to cut down, significant time spent obtaining/using/recovering, important activities given up, continued use despite knowledge of physical/psychological problems
- ✓Documentation that the psychotic disorder with hallucinations 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
- •F10.1x — Alcohol abuse codes; abuse is a less severe pattern — if documentation says 'dependence,' do not downcode to abuse
- •F10.9x — Alcohol use, unspecified; always code dependence when documented, as it carries appropriate risk adjustment weight
- •F20.x — Schizophrenia spectrum disorders; primary psychotic disorders are independent of substance use — verify temporal relationship to alcohol