F13.151 maps to CMS-HCC V28 135. 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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Code lookupF13.151

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)

F13.151

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

Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations

Misuse of sedatives, sleeping pills, or anti-anxiety medications that causes psychotic symptoms, specifically seeing or hearing things that aren't real (hallucinations).

Buddy Insight

Sedative-induced hallucinations during abuse represent an acute psychiatric emergency where the patient is perceiving things that are not real, directly caused by substance misuse.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 135

Drug Use with Psychotic Compl...

Coefficient HCC 135: 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 081

HHS-HCC 081 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 54

Substance Use with Psychotic ...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F13.1Sedative, hypnotic or anxiolytic-related abuse F13.15Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder F13.151Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations

Inclusion Terms

Official

No inclusion terms are included in this display for F13.151. 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

F13.150Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions F13.159Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified

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

Official

No Code First sequencing instructions are included in this display for F13.151. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F13.151. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F13.151. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Identification of the specific sedative, hypnotic, or anxiolytic substance being abused

Type of hallucinations documented (auditory, visual, tactile, olfactory)

Temporal relationship between substance use and onset of hallucinations

Clinical distinction from primary psychotic disorders documented in assessment

MEAT Support

HCC Buddy guidance

Identification of the specific sedative, hypnotic, or anxiolytic substance being abused

Type of hallucinations documented (auditory, visual, tactile, olfactory)

Temporal relationship between substance use and onset of hallucinations

Clinical distinction from primary psychotic disorders documented in assessment

Audit Caution

HCC Buddy guidance

Misclassifying hallucinations as delusions — hallucinations are sensory (seeing/hearing things), delusions are belief-based

Assigning dependence codes (F13.2x) when documentation only supports abuse criteria

Failing to code the psychotic complication and defaulting to uncomplicated abuse (F13.10)

Not documenting the substance-induced nature, leading to confusion with primary psychotic disorders

Common Mistakes

HCC Buddy guidance

F13.150 — Sedative abuse with delusions rather than hallucinations; delusions are false beliefs, not false perceptions

F13.159 — Unspecified psychotic disorder from sedative abuse; use only when hallucinations vs delusions cannot be determined

F13.251 — Sedative DEPENDENCE with hallucinations; requires dependence criteria rather than abuse

F13.232 — Sedative dependence withdrawal with perceptual disturbance; occurs during withdrawal, not active intoxication

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 F13.151 an HCC code?

Yes. F13.151 (Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations) maps to HCC 135, Drug Use with 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: F13.151 is billable and maps to V28 HCC 135, Drug Use with Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F13.151
Description: Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations
HCC (V28): HCC 135 — Drug Use with Psychotic Complications
RAF reference coefficient: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 135, Drug Use with Psychotic Complications

0.424

ESRDHCC 54, Substance Use with Psychotic 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 F13.151 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F13.151

For F13.151, 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

F13.151 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations. Misuse of sedatives, sleeping pills, or anti-anxiety medications that causes psychotic symptoms, specifically seeing or hearing things that aren't real (hallucinations). F13.151 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, F13.151 maps to Drug Use with Psychotic Complications (HCC 135) 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.

Specify the type of hallucinations (auditory, visual, tactile) in documentation when available. For F13.151, 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 F13.151 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Specify the type of hallucinations (auditory, visual, tactile) in documentation when available
•This code reflects substance-induced hallucinations rather than primary psychotic disorder

Clinical Significance

Sedative-induced hallucinations during abuse represent an acute psychiatric emergency where the patient is perceiving things that are not real, directly caused by substance misuse. This condition requires differentiation from primary psychotic disorders and carries implications for patient safety and treatment planning. The higher HCC mapping to Drug/Alcohol Psychosis reflects the clinical severity of this presentation.

Documentation Requirements

✓Identification of the specific sedative, hypnotic, or anxiolytic substance being abused
✓Type of hallucinations documented (auditory, visual, tactile, olfactory)
✓Temporal relationship between substance use and onset of hallucinations
✓Clinical distinction from primary psychotic disorders documented in assessment
✓Pattern of use meeting abuse criteria (not dependence)
✓Mental status examination documenting hallucination findings

Commonly Confused Codes

•F13.150: Sedative abuse with delusions rather than hallucinations; delusions are false beliefs, not false perceptions
•F13.159: Unspecified psychotic disorder from sedative abuse; use only when hallucinations vs delusions cannot be determined
•F13.251: Sedative DEPENDENCE with hallucinations; requires dependence criteria rather than abuse
•F13.232: Sedative dependence withdrawal with perceptual disturbance; occurs during withdrawal, not active intoxication
•F10.151: Alcohol abuse with psychotic disorder with hallucinations; wrong substance category