F13.27
BillableSedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting dementia
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.27 an HCC code?
Yes. F13.27 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 F13.27
For F13.27 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 F13.27 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.27 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting dementia. A person is dependent on sedatives, sleeping pills, or anti-anxiety medications and has developed progressive cognitive decline and dementia caused by these drugs. F13.27 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, F13.27 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F13.27 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.
Ensure documentation distinguishes substance-induced dementia from primary neurodegenerative dementias. Because F13.27 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 F13.27 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure documentation distinguishes substance-induced dementia from primary neurodegenerative dementias
- •Note the timeline of cognitive decline in relation to substance use initiation
Clinical Significance
Sedative-induced persisting dementia is one of the most severe long-term consequences of sedative dependence, representing irreversible global cognitive decline caused by chronic substance use. Unlike the amnestic disorder, dementia involves multiple cognitive domains including memory, executive function, language, and visuospatial abilities. This diagnosis significantly impacts functional independence and care needs.
Documentation Requirements
- ✓Documentation of sedative, hypnotic, or anxiolytic dependence history
- ✓Neuropsychological testing showing decline in multiple cognitive domains
- ✓Evidence the dementia persists beyond substance cessation
- ✓Temporal relationship between chronic substance use and cognitive decline onset
- ✓Distinction from primary neurodegenerative dementias (Alzheimer disease, vascular dementia)
- ✓Functional assessment documenting impact on activities of daily living and instrumental activities
- ✓Brain imaging results if available (MRI/CT showing atrophy patterns)