What is ICD-10 code F14.251?

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 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F14.251 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F14.251 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F14.251 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for F14.251?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For F14.251, V28 maps to Drug/Alcohol Psychosis at RAF 0.000 while V24 mapped to Drug/Alcohol Psychosis at RAF 0.434. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting F14.251?

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 Because F14.251 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

F14.251 ICD-10 Code: Cocaine dependence

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupF14.251Effective 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)

F14.251

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

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.

Buddy Insight

Cocaine dependence with cocaine-induced psychotic disorder with hallucinations indicates a dependent patient experiencing hallucinations directly caused by cocaine.

CMS-HCC V28

Mapped

HCC 135

Drug/Alcohol Psychosis

RAF 0.0

CMS-HCC V24

Mapped

HCC 54

Drug/Alcohol Psychosis

RAF 0.434

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 54

Drug/Alcohol Psychosis

RAF 0.0

RXHCC

Not risk-adjusted for this model/period.

RAF 0

Code Trumping

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Compare selected patient codes to show trumped or trumps impact.

Code Book Path

Official

F14.2Cocaine dependence

F14.25Cocaine dependence with cocaine-induced psychotic disorder

F14.251Cocaine dependence with cocaine-induced psychotic disorder with hallucinations

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F14.251 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F14.251 in this effective period.

Related Child Codes

Official

F14.250Cocaine dependence with cocaine-induced psychotic disorder with delusions

F14.259Cocaine dependence with cocaine-induced psychotic disorder, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for F14.251 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F14.251 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F14.251 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F14.251 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F14.251 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Using this code for brief perceptual disturbances during intoxication that do not meet psychotic disorder criteria

Not documenting the specific type of hallucination

Failing to differentiate cocaine-induced hallucinations from primary psychiatric conditions

Coding abuse when the substance use pattern meets dependence criteria

Common Mistakes

HCC Buddy guidance

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

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

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

V28HCC 135, Drug/Alcohol Psychosis

0.000

V24HCC 54, Drug/Alcohol Psychosis

0.434

ESRDHCC 54, Drug/Alcohol Psychosis

0.000

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 F14.251to 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