F14.251
BillableCocaine dependence with cocaine-induced psychotic disorder with hallucinations
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F14.251 an HCC code?
Yes. F14.251 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 F14.251
For F14.251 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 F14.251 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F14.251 is the ICD-10-CM diagnosis code for cocaine dependence with cocaine-induced psychotic disorder with hallucinations. A person is dependent on cocaine and is experiencing psychosis with hallucinations (seeing, hearing, or feeling things that aren't real) caused by the cocaine use. F14.251 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, F14.251 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F14.251 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 type of hallucinations present (visual, auditory, tactile) in the clinical record. Because F14.251 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 F14.251 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the type of hallucinations present (visual, auditory, tactile) in the clinical record
- •Ensure documentation clearly links the hallucinations to cocaine use rather than other causes
Clinical Significance
Cocaine dependence with cocaine-induced psychotic disorder with hallucinations indicates a dependent patient experiencing hallucinations directly caused by cocaine. Cocaine-related hallucinations are characteristically tactile (formication — the sensation of insects crawling under the skin) but can also be visual or auditory. This is a psychiatric emergency that may lead to self-injurious behavior (e.g., skin picking in response to tactile hallucinations) and requires both psychiatric stabilization and substance use treatment.
Documentation Requirements
- ✓Provider documentation of cocaine dependence
- ✓Clear documentation that hallucinations are cocaine-induced
- ✓Description of hallucination type (tactile, visual, auditory, olfactory)
- ✓Mental status examination documenting hallucinatory experiences
- ✓Documentation excluding primary psychotic disorders
- ✓Temporal relationship between cocaine use and hallucination onset
- ✓Assessment of patient response to hallucinations (behavioral changes, self-harm risk)
- ✓Evidence of any physical harm from hallucination-driven behavior (skin excoriation from formication)
Commonly Confused Codes
- •F14.250 — Cocaine dependence with cocaine-induced psychotic disorder with delusions: use when delusions are the primary symptom
- •F14.222 — Cocaine dependence with intoxication with perceptual disturbance: use for transient perceptual changes during intoxication not meeting psychosis criteria
- •F14.151 — Cocaine abuse with cocaine-induced psychotic disorder with hallucinations: use when the pattern is abuse
- •F14.259 — Cocaine dependence with cocaine-induced psychotic disorder, unspecified: use when psychosis type is not specified
- •F20.x — Schizophrenia: use when hallucinations are from primary psychotic disorder