F13.159
BillableSedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.159 an HCC code?
Yes. F13.159 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 F13.159
For F13.159 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 F13.159 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.159 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified. Misuse of sedatives, sleeping pills, or anti-anxiety medications that causes psychotic symptoms, but the specific type of psychotic symptom is not specified. F13.159 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, F13.159 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F13.159 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 psychosis is documented but type (delusions vs. hallucinations) cannot be determined. Because F13.159 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 F13.159 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
This unspecified psychotic disorder code indicates the patient is experiencing substance-induced psychosis from sedative abuse, but the specific symptom type is not documented. While it still captures the severity of psychotic complication, using this code represents an opportunity for documentation improvement. Clinical querying could yield more specific coding with F13.150 or F13.151.
Documentation Requirements
- ✓Documentation of sedative, hypnotic, or anxiolytic abuse pattern
- ✓Evidence of psychotic symptoms caused by the substance (even if type is not specified)
- ✓Temporal link between substance use and psychotic episode
- ✓Clinical assessment ruling out primary psychotic disorders
- ✓Note indicating the specific type of psychosis could not be determined from available documentation
Commonly Confused Codes
- •F13.150 — Use when delusions are specifically documented
- •F13.151 — Use when hallucinations are specifically documented
- •F13.19 — Abuse with unspecified induced disorder; this is broader than psychosis-specific F13.159
- •F13.259 — Sedative DEPENDENCE with unspecified psychotic disorder; requires dependence rather than abuse
- •F13.959 — Unspecified use with psychotic disorder; use when abuse vs dependence is not documented