F10.259 ICD-10-CM Code: Alcohol dependence with alcohol-induced psychotic disorder, unspecified

Code

F10.259

Description

Alcohol dependence 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

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 F10.259 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F10.259

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for F10.259 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Verify that the psychotic symptoms are documented as alcohol-induced and not due to a separate psychotic disorder; if the psychotic disorder exists independently, use a different code
• •Ensure the medical record clearly documents both alcohol dependence and the presence of psychotic symptoms; if only one condition is present, use the appropriate single-condition code instead

Clinical Significance

This code captures alcohol dependence 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 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, 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

• •F10.1x: 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

Child Codes