F12.13 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupF12.13

Effective 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)

F12.13

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

Cannabis abuse with withdrawal

A person is abusing cannabis and is experiencing withdrawal symptoms after reducing or stopping their use.

Buddy Insight

Cannabis abuse with withdrawal is clinically significant because it documents a recognized cannabis withdrawal syndrome in a patient with an abuse-level use disorder.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 137

Drug Use Disorder, Moderate/S...

Coefficient HCC 137: 0.424 (Community Non-Dual Aged (CNA))

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 082

HHS-HCC 082 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 55

Substance Use Disorder/Modera...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

Inclusion Terms

Official

No inclusion terms are included in this display for F12.13. Check the code and parent instructions in the Code Book.

Excludes 2

Official

symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99

Related Codes

Official

F12.10Cannabis abuse, uncomplicated F12.11Cannabis abuse, in remission F12.12Cannabis abuse with intoxication F12.15Cannabis abuse with psychotic disorder F12.18Cannabis abuse with other cannabis-induced disorder

Includes

Official

disorders of psychological developmentInherited from F01-F99, F12
marijuanaInherited from F01-F99, F12

Excludes 1

Official

cannabis dependence (F12.2-)Inherited from F12.1
cannabis use, unspecified (F12.9-)Inherited from F12.1

Code First

Official

No Code First sequencing instructions are included in this display for F12.13. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F12.13. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F12.13. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of cannabis abuse (maladaptive use pattern)

Specific withdrawal symptoms documented (irritability, anxiety, insomnia, decreased appetite, restlessness, depressed mood, physical symptoms)

Temporal relationship between cessation or reduction of cannabis use and onset of withdrawal symptoms

Duration and severity of withdrawal symptoms

MEAT Support

HCC Buddy guidance

Documentation of cannabis abuse (maladaptive use pattern)

Specific withdrawal symptoms documented (irritability, anxiety, insomnia, decreased appetite, restlessness, depressed mood, physical symptoms)

Temporal relationship between cessation or reduction of cannabis use and onset of withdrawal symptoms

Duration and severity of withdrawal symptoms

Audit Caution

HCC Buddy guidance

Overlooking cannabis withdrawal as a valid clinical diagnosis — it is recognized in DSM-5 and ICD-10-CM

Coding withdrawal symptoms as independent psychiatric diagnoses rather than substance-induced

Assigning dependence codes when only abuse criteria are met, simply because withdrawal is present

Failing to document the specific withdrawal symptoms, which weakens the clinical justification

Common Mistakes

HCC Buddy guidance

F12.23 — Cannabis dependence with withdrawal; use when dependence (not abuse) is documented

F12.93 — Cannabis use, unspecified with withdrawal; use when severity of use disorder is unspecified

F12.10 — Cannabis abuse, uncomplicated; use when no withdrawal or other complications are present

F41.9 — Anxiety disorder, unspecified; do not use when anxiety is attributable to cannabis withdrawal

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 F12.13 an HCC code?

Yes. F12.13 (Cannabis abuse with withdrawal) maps to HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-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: F12.13 is billable and maps to V28 HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F12.13
Description: Cannabis abuse with withdrawal
HCC (V28): HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
RAF reference coefficient: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications

0.424

ESRDHCC 55, Substance Use Disorder/Moderate/Severe/Substance Use with 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 F12.13 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F12.13

For F12.13, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

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What This Code Means

F12.13 is the ICD-10-CM diagnosis code for cannabis abuse with withdrawal. A person is abusing cannabis and is experiencing withdrawal symptoms after reducing or stopping their use. F12.13 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, F12.13 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a source-labeled community, non-dual, aged reference coefficient of 0.424. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. 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.

Document specific withdrawal symptoms such as irritability, sleep disturbance, anxiety, or decreased appetite. For F12.13, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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 F12.13 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document specific withdrawal symptoms such as irritability, sleep disturbance, anxiety, or decreased appetite
•Cannabis withdrawal is now recognized in DSM-5, so ensure the symptoms are clearly attributed to cannabis cessation

Clinical Significance

Cannabis abuse with withdrawal is clinically significant because it documents a recognized cannabis withdrawal syndrome in a patient with an abuse-level use disorder. Cannabis withdrawal — now formally recognized in the DSM-5 — can include irritability, anxiety, insomnia, decreased appetite, and restlessness. Documenting withdrawal is important because it indicates physiological adaptation to cannabis and may signal progression toward dependence.

Documentation Requirements

✓Documentation of cannabis abuse (maladaptive use pattern)
✓Specific withdrawal symptoms documented (irritability, anxiety, insomnia, decreased appetite, restlessness, depressed mood, physical symptoms)
✓Temporal relationship between cessation or reduction of cannabis use and onset of withdrawal symptoms
✓Duration and severity of withdrawal symptoms
✓Exclusion of other causes for the symptoms

Commonly Confused Codes

•F12.23: Cannabis dependence with withdrawal; use when dependence (not abuse) is documented
•F12.93: Cannabis use, unspecified with withdrawal; use when severity of use disorder is unspecified
•F12.10: Cannabis abuse, uncomplicated; use when no withdrawal or other complications are present
•F41.9: Anxiety disorder, unspecified; do not use when anxiety is attributable to cannabis withdrawal