F12.951
BillableCannabis use, unspecified with psychotic disorder with hallucinations
HCC Category Mapping
What This Code Means
A person uses cannabis in an unspecified pattern and is experiencing a mental health condition involving hallucinations (seeing or hearing things that aren't real). This code indicates the cannabis use and psychotic symptoms are related.
Coding Tips
- •Verify documentation clearly links cannabis use to the psychotic symptoms with hallucinations; if the relationship is unclear, query the provider before coding
- •Ensure the cannabis use pattern is documented; if specific frequency/remission status cannot be determined, 'unspecified' is appropriate, but check for any documentation of use severity
Clinical Significance
Cannabis use, unspecified with psychotic disorder with hallucinations documents cannabis-induced psychosis featuring hallucinations when the use disorder severity is not specified. Hallucinations persisting beyond intoxication in the context of cannabis use represent a significant psychiatric emergency. This diagnosis is important for both clinical management and risk adjustment, as it captures the highest substance use HCC category in the V24 model.
Documentation Requirements
- ✓Documentation of cannabis use
- ✓Description of specific hallucinations (auditory, visual, tactile, olfactory)
- ✓Clinical statement that hallucinations are cannabis-induced
- ✓Evidence that hallucinations persist beyond the intoxication period
- ✓Mental status examination documenting hallucinatory experiences
- ✓Exclusion of primary psychotic disorders and other causes of hallucinations