F10.97
BillableAlcohol use, unspecified with alcohol-induced persisting dementia
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F10.97 an HCC code?
Yes. F10.97 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 F10.97
For F10.97 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 F10.97 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F10.97 is the ICD-10-CM diagnosis code for alcohol use, unspecified with alcohol-induced persisting dementia. Progressive brain damage and cognitive decline caused by long-term heavy alcohol use, resulting in memory loss, confusion, and difficulty with daily functioning. F10.97 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, F10.97 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, F10.97 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.
Ensure documentation distinguishes alcohol-induced dementia from other types of dementia or age-related cognitive decline. Because F10.97 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 F10.97 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure documentation distinguishes alcohol-induced dementia from other types of dementia or age-related cognitive decline
- •Code the severity level if documented, and consider coding any associated behavioral or psychiatric symptoms separately
Clinical Significance
Alcohol-induced persisting dementia represents progressive, irreversible cognitive deterioration caused by chronic heavy alcohol use, affecting memory, executive function, judgment, and daily living skills. This is among the most severe complications of alcohol use and indicates a high level of ongoing care needs including possible long-term care placement.
Documentation Requirements
- ✓Provider diagnosis of alcohol-induced persisting dementia
- ✓Documentation of global cognitive decline (not just memory — must include impaired judgment, executive dysfunction, personality changes)
- ✓History of chronic heavy alcohol use establishing causal relationship
- ✓Cognitive assessment or neuropsychological testing results
- ✓Documentation that dementia persists after alcohol cessation
- ✓Functional status assessment and level of care needed
- ✓Assessment ruling out other dementia etiologies (Alzheimer disease, vascular, Lewy body)
Commonly Confused Codes
- •F10.96 — Alcohol use, unspecified with persisting amnestic disorder: use when impairment is limited to memory without global cognitive decline
- •F10.27 — Alcohol dependence with persisting dementia: use when dependence is established
- •G31.2 — Degeneration of nervous system due to alcohol: use for neurological degeneration without dementia
- •F03.90 — Unspecified dementia without behavioral disturbance: use when dementia is NOT alcohol-induced