F10.96
BillableAlcohol use, unspecified with alcohol-induced persisting amnestic disorder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F10.96 an HCC code?
Yes. F10.96 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 F10.96
For F10.96 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 F10.96 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F10.96 is the ICD-10-CM diagnosis code for alcohol use, unspecified with alcohol-induced persisting amnestic disorder. A long-term memory disorder caused by chronic alcohol use where the person has difficulty forming new memories and may have gaps in past memories. F10.96 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, F10.96 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, F10.96 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.
This code indicates a persistent condition that continues even after alcohol use stops, distinguishing it from acute alcohol-related confusion. Because F10.96 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 F10.96 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code indicates a persistent condition that continues even after alcohol use stops, distinguishing it from acute alcohol-related confusion
- •Document evidence of memory impairment and its relationship to chronic alcohol consumption in the clinical record
Clinical Significance
Alcohol-induced persisting amnestic disorder (Korsakoff syndrome) is a chronic neurological condition caused by thiamine deficiency from prolonged alcohol use, resulting in severe anterograde amnesia and confabulation. This condition is irreversible in most cases and indicates end-stage alcohol-related brain damage, requiring ongoing supportive care and supervision.
Documentation Requirements
- ✓Provider diagnosis of alcohol-induced persisting amnestic disorder or Korsakoff syndrome
- ✓Documentation of memory impairment (inability to form new memories, gaps in past memories)
- ✓Evidence of chronic/heavy alcohol use history
- ✓Assessment distinguishing from other dementias or acute confusional states
- ✓Documentation that the amnesia persists beyond acute intoxication or withdrawal
- ✓Neuropsychological testing results if available