F13.99 maps to CMS-HCC V28 137. 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 lookupF13.99

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

F13.99

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

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

A person uses sedative, hypnotic, or anti-anxiety medications without a diagnosed substance use disorder and develops some type of disorder related to these drugs, but the specific disorder is not identified.

Buddy Insight

This is the least specific code in the sedative use disorder category — both the use pattern and the induced disorder type are unspecified.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 137

Drug Use Disorder, Moderate/S...

Coefficient HCC 137: 0.424 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 082

HHS-HCC 082 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 55

Substance Use Disorder/Modera...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F13Sedative, hypnotic, or anxiolytic related disorders F13.9Sedative, hypnotic or anxiolytic-related use, unspecified F13.99Sedative, hypnotic or anxiolytic use, unspecified with unspecified sedative, hypnotic or anxiolytic-induced disorder

Inclusion Terms

Official

No inclusion terms are included in this display for F13.99. 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

F13.90Sedative, hypnotic, or anxiolytic use, unspecified, uncomplicated F13.91Sedative, hypnotic or anxiolytic use, unspecified, in remission F13.92Sedative, hypnotic or anxiolytic use, unspecified with intoxication F13.93Sedative, hypnotic or anxiolytic use, unspecified with withdrawal F13.94Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced mood disorder

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 F13.99. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F13.99. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F13.99. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of sedative, hypnotic, or anxiolytic use

Evidence that some type of substance-induced disorder exists

Clinical note acknowledging the complication

Notation explaining why neither the use pattern nor induced disorder could be specified

MEAT Support

HCC Buddy guidance

Documentation of sedative, hypnotic, or anxiolytic use

Evidence that some type of substance-induced disorder exists

Clinical note acknowledging the complication

Notation explaining why neither the use pattern nor induced disorder could be specified

Audit Caution

HCC Buddy guidance

Accepting this doubly unspecified code without querying the provider

Not reviewing the record for details that would support more specific codes

Confusing this with the 'no induced disorder' code F13.90

Defaulting to this code without attempting chart review for specificity

Common Mistakes

HCC Buddy guidance

F13.90 — Unspecified sedative use without induced disorder; no complication present

F13.988 — Unspecified use with other specified induced disorder; disorder is known but atypical

F13.94 — Unspecified use with induced mood disorder; when mood symptoms are identified

F13.980 — Unspecified use with induced anxiety; when anxiety is identified

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 F13.99 an HCC code?

Yes. F13.99 (Sedative, hypnotic or anxiolytic use, unspecified with unspecified sedative, hypnotic or anxiolytic-induced disorder) maps to HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-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: F13.99 is billable and maps to V28 HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F13.99
Description: Sedative, hypnotic or anxiolytic use, unspecified with unspecified sedative, hypnotic or anxiolytic-induced disorder
HCC (V28): HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
RAF reference coefficient: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications

0.424

ESRDHCC 55, Substance Use Disorder/Moderate/Severe/Substance Use with 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 F13.99 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F13.99

For F13.99, 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

F13.99 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic use, unspecified with unspecified sedative, hypnotic or anxiolytic-induced disorder. A person uses sedative, hypnotic, or anti-anxiety medications without a diagnosed substance use disorder and develops some type of disorder related to these drugs, but the specific disorder is not identified. F13.99 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, F13.99 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) 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.

Use this code only when the induced disorder cannot be specified; if the specific disorder (anxiety, sleep, mood, etc.) is known, use the more specific code. For F13.99, 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 F13.99 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 induced disorder cannot be specified; if the specific disorder (anxiety, sleep, mood, etc.) is known, use the more specific code
•Review clinical documentation to determine if a more specific F13.98x code would be more appropriate

Clinical Significance

This is the least specific code in the sedative use disorder category — both the use pattern and the induced disorder type are unspecified. It indicates a provider documented sedative use with some type of induced problem, but neither axis has been clarified. This represents the maximum documentation improvement opportunity and should trigger provider queries on both dimensions.

Documentation Requirements

✓Documentation of sedative, hypnotic, or anxiolytic use
✓Evidence that some type of substance-induced disorder exists
✓Clinical note acknowledging the complication
✓Notation explaining why neither the use pattern nor induced disorder could be specified
✓Assessment and plan addressing the condition

Commonly Confused Codes

•F13.90: Unspecified sedative use without induced disorder; no complication present
•F13.988: Unspecified use with other specified induced disorder; disorder is known but atypical
•F13.94: Unspecified use with induced mood disorder; when mood symptoms are identified
•F13.980: Unspecified use with induced anxiety; when anxiety is identified
•F13.19: Sedative ABUSE with unspecified induced disorder; when abuse is confirmed