What is ICD-10 code F13.151?

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 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F13.151 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F13.151 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F13.151 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for F13.151?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For F13.151, V28 maps to Drug/Alcohol Psychosis at RAF 0.000 while V24 mapped to Drug/Alcohol Psychosis at RAF 0.434. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting F13.151?

Specify the type of hallucinations (auditory, visual, tactile) in documentation when available This code reflects substance-induced hallucinations rather than primary psychotic disorder Because F13.151 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

F13.151 ICD-10 Code: Sedative, hypnotic

ICD-10-CM Code View

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Code lookupF13.151Effective 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.

CMS-HCC V28

Mapped

HCC 135

Drug/Alcohol Psychosis

RAF 0.0

CMS-HCC V24

Mapped

HCC 54

Drug/Alcohol Psychosis

RAF 0.434

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 54

Drug/Alcohol Psychosis

RAF 0.0

RXHCC

Not risk-adjusted for this model/period.

RAF 0

Code Trumping

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Compare selected patient codes to show trumped or trumps impact.

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

ICD-10-CM does not list inclusion terms for F13.151 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F13.151 in this effective period.

Related Child 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

ICD-10-CM does not list Includes notes for F13.151 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F13.151 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F13.151 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F13.151 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F13.151 in this effective period.

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

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is F13.151 an HCC code?

Yes. F13.151 maps to Drug/Alcohol Psychosis under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Psychosis under V24).

HCC Category Mapping

V28HCC 135, Drug/Alcohol Psychosis

0.000

V24HCC 54, Drug/Alcohol Psychosis

0.434

ESRDHCC 54, Drug/Alcohol Psychosis

0.000

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 F13.151

For F13.151to 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 F13.151 during that encounter, not just copy-forwarded from a problem list.

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/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F13.151 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.

Specify the type of hallucinations (auditory, visual, tactile) in documentation when available. Because F13.151 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 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