F13.988
BillableSedative, hypnotic or anxiolytic use, unspecified with other sedative, hypnotic or anxiolytic-induced disorder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.988 an HCC code?
Yes. F13.988 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Dependence 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 F13.988
For F13.988 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 F13.988 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.988 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic use, unspecified with other sedative, hypnotic or anxiolytic-induced disorder. This code describes a situation where someone is using sedative, hypnotic, or anxiolytic medications (drugs that calm or help with sleep) in an unspecified way and has developed another related health problem caused by these drugs. The specific type of problem is not further detailed in this code. F13.988 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, F13.988 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe (HCC 137) with a community, non-dual, aged base RAF weight of 0.358. Under the older CMS-HCC V24 model, F13.988 maps to Drug/Alcohol Dependence (HCC 55) with a community, non-dual, aged base RAF weight of 0.334. 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 the documentation indicates sedative/hypnotic/anxiolytic use with an induced disorder that doesn't fit more specific F13 subcategories (such as F13.980 for anxiety or F13.982 for sleep disorder). Because F13.988 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 F13.988 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the documentation indicates sedative/hypnotic/anxiolytic use with an induced disorder that doesn't fit more specific F13 subcategories (such as F13.980 for anxiety or F13.982 for sleep disorder)
- •Verify the documentation clearly states the disorder is induced by the sedative/hypnotic/anxiolytic use rather than being a pre-existing condition, and confirm the pattern of use is unspecified (not in remission, early remission, or sustained remission)
Clinical Significance
This code captures other specified substance-induced disorders from unspecified sedative use that do not fit standard categories. It serves as a catch-all for unusual complications that are known but do not match anxiety, sexual, sleep, mood, or psychotic disorder classifications. Examples include substance-induced obsessive-compulsive symptoms or movement disorders.
Documentation Requirements
- ✓Documentation of sedative, hypnotic, or anxiolytic use
- ✓Clear description of the specific induced disorder
- ✓Provider documentation establishing causal link to the substance
- ✓Clinical rationale for why more specific codes do not apply
- ✓Assessment supporting the diagnosis
- ✓Treatment plan for both substance use and the induced disorder
Commonly Confused Codes
- •F13.99 — Unspecified use with unspecified induced disorder; use when disorder type is unknown
- •F13.980 — Induced anxiety disorder; use if anxiety is the specific condition
- •F13.982 — Induced sleep disorder; use if sleep problems are the specific condition
- •F13.188 — Sedative ABUSE with other induced disorder; when abuse is confirmed
- •F13.288 — Sedative DEPENDENCE with other induced disorder; when dependence is confirmed