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F13.951 ICD-10-CM Code: Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations

F13.951 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 Buddy coding tools

ICD-10-CM Code View

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Code lookupF13.951

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)

F13.951

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

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

A person is experiencing hallucinations (seeing, hearing, or sensing things that aren't there) caused by sedative, hypnotic, or anti-anxiety medication use.

Buddy the Bee presenting code insight

Buddy Insight

Unspecified sedative use with induced hallucinations is a severe psychiatric complication requiring urgent attention.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

HCC 135

Coefficient HCC 135: 0.424 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 081

Code-level coefficient reference

ESRD/PACE

HCC 54

Code-level coefficient reference

RXHCC

N/A

—

Not mapped

Code Book Path

Official
F13.9Sedative, hypnotic or anxiolytic-related use, unspecifiedF13.95Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorderF13.951Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations

Inclusion Terms

Official

No inclusion terms are included in this display for F13.951. 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
F13.950Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusionsF13.959Sedative, hypnotic or anxiolytic use, unspecified 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 abuse (F13.1-)Inherited from F13.9
  • sedative, hypnotic or anxiolytic-related dependence (F13.2-)Inherited from F13.9

Code First

Official

No Code First sequencing instructions are included in this display for F13.951. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F13.951. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F13.951. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
Documentation of sedative, hypnotic, or anxiolytic use
Type of hallucinations documented (visual, auditory, tactile, olfactory)
Clinical evidence establishing substance-induced origin
Mental status examination documenting hallucinatory content

MEAT Support

HCC Buddy guidance
Documentation of sedative, hypnotic, or anxiolytic use
Type of hallucinations documented (visual, auditory, tactile, olfactory)
Clinical evidence establishing substance-induced origin
Mental status examination documenting hallucinatory content

Audit Caution

HCC Buddy guidance
Confusing substance-induced hallucinations (during active use) with withdrawal perceptual disturbances
Using the unspecified psychotic disorder code when hallucinations are clearly documented
Coding hallucinations as delusions or vice versa
Missing the higher psychosis HCC by coding only the substance use

Common Mistakes

HCC Buddy guidance
F13.950 — Unspecified use with induced delusions; different psychotic symptom type
F13.959 — Unspecified use with unspecified psychotic disorder; use when type cannot be determined
F13.932 — Unspecified use with withdrawal perceptual disturbance; withdrawal context, not active use
F13.151 — Sedative ABUSE with hallucinations; when abuse is confirmed

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 F13.951 an HCC code?

Yes. F13.951 (Sedative, hypnotic or anxiolytic use, unspecified 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: F13.951 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
F13.951
Description
Sedative, hypnotic or anxiolytic use, unspecified 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 F13.951 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F13.951

For F13.951, 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

F13.951 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations. A person is experiencing hallucinations (seeing, hearing, or sensing things that aren't there) caused by sedative, hypnotic, or anti-anxiety medication use. F13.951 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, F13.951 maps to Drug Use with Psychotic Complications (HCC 135) with a source-labeled community, non-dual, aged reference coefficient of 0.424. No V24 mapping is shown for F13.951; use the applicable model and payment year when reviewing the V28 mapping. 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 (visual, auditory, tactile, etc.) in clinical documentation. For F13.951, 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 F13.951 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 (visual, auditory, tactile, etc.) in clinical documentation
  • •Differentiate from withdrawal-related perceptual disturbances by documenting the clinical context and substance use pattern

Clinical Significance

Unspecified sedative use with induced hallucinations is a severe psychiatric complication requiring urgent attention. The patient is experiencing false sensory perceptions directly caused by sedative use. This condition requires differentiation from primary psychotic disorders, withdrawal-related perceptual disturbances, and other substance-induced psychotic states. The hallucination type guides treatment approach.

Documentation Requirements

  • ✓Documentation of sedative, hypnotic, or anxiolytic use
  • ✓Type of hallucinations documented (visual, auditory, tactile, olfactory)
  • ✓Clinical evidence establishing substance-induced origin
  • ✓Mental status examination documenting hallucinatory content
  • ✓Timeline of substance use and hallucination onset
  • ✓Safety assessment and treatment plan

Commonly Confused Codes

  • •F13.950: Unspecified use with induced delusions; different psychotic symptom type
  • •F13.959: Unspecified use with unspecified psychotic disorder; use when type cannot be determined
  • •F13.932: Unspecified use with withdrawal perceptual disturbance; withdrawal context, not active use
  • •F13.151: Sedative ABUSE with hallucinations; when abuse is confirmed
  • •F13.251: Sedative DEPENDENCE with hallucinations; when dependence is confirmed

Child Codes

F13.950Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions
HCC 135
F13.951Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations
HCC 135
F13.959Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
HCC 135

Code Hierarchy

└F13Sedative, hypnotic, or anxiolytic related disorders└F13.9Sedative, hypnotic or anxiolytic-related use, unspecified└F13.95Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder└F13.951Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations
└F13.951Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations

Also searched as

  • F13 951
  • F13951

For F13.951, 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.

F13.951 maps to CMS-HCC V28 category 135, Drug Use with Psychotic Complications. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for F13.951. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

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