F12.159
BillableCannabis abuse with psychotic disorder, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F12.159 an HCC code?
Yes. F12.159 maps to Drug/Alcohol Psychosis 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 F12.159
For F12.159 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 F12.159 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F12.159 is the ICD-10-CM diagnosis code for cannabis abuse with psychotic disorder, unspecified. A person is abusing cannabis and has developed a psychotic disorder caused by cannabis, but the specific type of psychotic symptoms is not specified. F12.159 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, F12.159 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F12.159 mapped to the same category but with a base RAF weight of 0.434 — V28 recalibrated weights across the entire model. 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.
Use this code only when psychotic disorder is documented but the specific features (delusions vs. hallucinations) are not clearly documented. Because F12.159 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 F12.159 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when psychotic disorder is documented but the specific features (delusions vs. hallucinations) are not clearly documented
- •Query the provider for clarification on the type of psychotic symptoms to assign a more specific code if possible
Clinical Significance
Cannabis abuse with unspecified psychotic disorder is used when cannabis-induced psychosis is documented but the specific type of psychotic symptoms — whether delusions or hallucinations — is not specified. This code still captures the clinical severity of substance-induced psychosis but represents a documentation opportunity. Providers should be queried to determine the specific psychotic features for more precise coding.
Documentation Requirements
- ✓Documentation of cannabis abuse
- ✓Statement that psychotic disorder is present and induced by cannabis
- ✓Any available description of psychotic symptoms
- ✓Temporal relationship between cannabis use and psychotic symptoms
- ✓Evidence that provider was queried regarding specific psychotic features