F13.97
BillableSedative, hypnotic or anxiolytic use, unspecified 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 F13.97 an HCC code?
Yes. F13.97 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 F13.97
For F13.97 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 F13.97 during that encounter — not just copy-forwarded from a problem list.
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/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F13.97 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.
Document the timeline of substance use and progression of cognitive decline to establish causality. Because F13.97 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 F13.97 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