F13.10 ICD-10-CM Code: Sedative, hypnotic or anxiolytic abuse, uncomplicated
F13.10 maps to CMS-HCC V28 138. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)
F13.10
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceSedative, hypnotic or anxiolytic abuse, uncomplicated
A person misuses sedatives, sleeping pills, or anti-anxiety medications without meeting criteria for dependence, and has no current complications.
Buddy Insight
Sedative, hypnotic, or anxiolytic abuse, uncomplicated, captures the misuse of benzodiazepines, barbiturates, sleeping pills, or similar medications without current complications.
CMS-HCC V28
MappedHCC 138
Coefficient HCC 138: 0.423 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
MappedHCC 56
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Sedative, hypnotic, or anxiolytic use disorder, mild
Excludes 2
Official- symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99
Related Codes
Includes
Official- disorders of psychological developmentInherited from F01-F99
Excludes 1
Official- sedative, hypnotic or anxiolytic-related dependence (F13.2-)Inherited from F13.1
- sedative, hypnotic, or anxiolytic use, unspecified (F13.9-)Inherited from F13.1
Code First
OfficialNo Code First sequencing instructions are included in this display for F13.10. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F13.10. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F13.10. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 F13.10 an HCC code?
Yes. F13.10 (Sedative, hypnotic or anxiolytic abuse, uncomplicated) maps to HCC 138, Drug Use Disorder, Mild, Uncomplicated, Except Cannabis under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.423. 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: F13.10 is billable and maps to V28 HCC 138, Drug Use Disorder, Mild, Uncomplicated, Except Cannabis. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- F13.10
- Description
- Sedative, hypnotic or anxiolytic abuse, uncomplicated
- HCC (V28)
- HCC 138 — Drug Use Disorder, Mild, Uncomplicated, Except Cannabis
- RAF reference coefficient
- 0.423
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 F13.10 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F13.10
For F13.10, 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
F13.10 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic abuse, uncomplicated. A person misuses sedatives, sleeping pills, or anti-anxiety medications without meeting criteria for dependence, and has no current complications. F13.10 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, F13.10 maps to Drug Use Disorder, Mild, Uncomplicated, Except Cannabis (HCC 138) with a source-labeled community, non-dual, aged reference coefficient of 0.423. 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.
Sedative, hypnotic, or anxiolytic abuse, uncomplicated. Most commonly seen with benzodiazepine misuse documented in the problem list. Provider narrative must describe the abuse pattern. For F13.10, 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 F13.10 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Sedative, hypnotic, or anxiolytic abuse, uncomplicated. Most commonly seen with benzodiazepine misuse documented in the problem list. Provider narrative must describe the abuse pattern.
- •Do not confuse F13.10 with F13.20 (dependence). Abuse and dependence are distinct severities. Also, legitimate short-term anxiolytic therapy without abuse features does not warrant F13.*.
- •Less commonly coded than alcohol or opioid disorders, but uncomplicated sedative/hypnotic/anxiolytic abuse maps to the mild drug-use HCC.
Clinical Significance
Sedative, hypnotic, or anxiolytic abuse, uncomplicated, captures the misuse of benzodiazepines, barbiturates, sleeping pills, or similar medications without current complications. This category of substance abuse is particularly important because many of these medications are prescribed, making the line between appropriate use and abuse critically important to document. Sedative abuse carries risks of respiratory depression, cognitive impairment, and falls, particularly in elderly patients.
Documentation Requirements
- ✓Documentation of abuse pattern (maladaptive use causing impairment or distress)
- ✓Identification of the specific substance(s) being abused (benzodiazepines, barbiturates, zolpidem, etc.) when possible
- ✓Distinction between prescribed use and misuse/abuse
- ✓Confirmation that no current complications (intoxication, withdrawal, psychosis) are present
- ✓Clinical criteria supporting abuse rather than dependence
Commonly Confused Codes
- •F13.20: Sedative, hypnotic or anxiolytic dependence, uncomplicated; use when dependence criteria are met
- •F13.11: Sedative, hypnotic or anxiolytic abuse, in remission; use when the patient is in recovery
- •F13.120: Sedative, hypnotic or anxiolytic abuse with intoxication, uncomplicated; use when active intoxication is present
- •Z79.899: Other long term (current) drug therapy; use for prescribed long-term sedative use without abuse