F13.97 ICD-10-CM Code: Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting dementia
F13.97 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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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)
F13.97
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceSedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting dementia
A person has developed persistent dementia (progressive cognitive decline) from long-term sedative, hypnotic, or anti-anxiety medication use.
Buddy Insight
Persisting dementia from unspecified sedative use represents irreversible global cognitive decline affecting multiple domains caused by chronic sedative exposure.
CMS-HCC V28
MappedHCC 135
Coefficient HCC 135: 0.424 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 081
Code-level coefficient reference
ESRD/PACE
MappedHCC 54
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Sedative, hypnotic, or anxiolytic-induced major neurocognitive disorder, without use disorder
Excludes 2
Official- symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99
Related Codes
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
OfficialNo Code First sequencing instructions are included in this display for F13.97. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F13.97. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F13.97. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 F13.97 an HCC code?
Yes. F13.97 (Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting dementia) 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: F13.97 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
- F13.97
- Description
- Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting dementia
- HCC (V28)
- HCC 135 — Drug Use with Psychotic Complications
- RAF reference coefficient
- 0.424
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 F13.97 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F13.97
For F13.97, 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
F13.97 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting dementia. A person has developed persistent dementia (progressive cognitive decline) from long-term sedative, hypnotic, or anti-anxiety medication use. F13.97 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, F13.97 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.
Document the timeline of substance use and progression of cognitive decline to establish causality. For F13.97, 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 F13.97 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the timeline of substance use and progression of cognitive decline to establish causality
- •Ensure this is coded as substance-induced dementia rather than primary neurodegenerative dementia; clarify with provider if uncertain
Clinical Significance
Persisting dementia from unspecified sedative use represents irreversible global cognitive decline affecting multiple domains caused by chronic sedative exposure. This is among the most devastating long-term consequences of sedative use, involving memory, executive function, language, and visuospatial abilities. Unlike the amnestic disorder (F13.96), this code indicates broader cognitive deterioration significantly impacting functional independence.
Documentation Requirements
- ✓Documentation of sedative, hypnotic, or anxiolytic use history
- ✓Neuropsychological testing showing decline across multiple cognitive domains
- ✓Evidence the dementia persists beyond substance cessation
- ✓Distinction from primary neurodegenerative dementias
- ✓Functional assessment documenting activities of daily living impact
- ✓Brain imaging if available to support the diagnosis
Commonly Confused Codes
- •F13.96: Unspecified use with persisting amnestic disorder; limited to memory only
- •F13.27: DEPENDENCE with persisting dementia; when dependence is confirmed
- •G30.9: Alzheimer disease, unspecified; primary neurodegenerative dementia
- •F03.90: Unspecified dementia; does not capture substance etiology
- •F01.50: Vascular dementia; different etiology