F14.259
BillableCocaine dependence with cocaine-induced psychotic disorder, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F14.259 an HCC code?
Yes. F14.259 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 F14.259
For F14.259 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 F14.259 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F14.259 is the ICD-10-CM diagnosis code for cocaine dependence with cocaine-induced psychotic disorder, unspecified. A person is dependent on cocaine and is experiencing psychosis caused by cocaine use, but the specific type (delusions or hallucinations) is not documented. F14.259 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, F14.259 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F14.259 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.
This is a less specific code; query the provider for clarification on whether delusions, hallucinations, or both are present. Because F14.259 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 F14.259 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a less specific code; query the provider for clarification on whether delusions, hallucinations, or both are present
- •Use only when the type of psychotic symptoms cannot be determined from documentation
Clinical Significance
Cocaine dependence with cocaine-induced psychotic disorder, unspecified captures the presence of cocaine-induced psychosis in a dependent patient without specification of whether the symptoms are delusions or hallucinations. While this still reflects a high-acuity condition requiring urgent psychiatric care, the unspecified nature represents a documentation opportunity. Providers should be queried to determine the specific psychotic symptom type for more precise coding.
Documentation Requirements
- ✓Provider documentation of cocaine dependence
- ✓Statement that psychotic symptoms are cocaine-induced
- ✓Documentation of psychotic symptoms present (even without specifying type)
- ✓Exclusion of primary psychotic disorders
- ✓Temporal relationship between cocaine use and psychosis onset
- ✓Mental status examination documenting psychotic features
- ✓Safety assessment
Commonly Confused Codes
- •F14.250 — Cocaine dependence with cocaine-induced psychotic disorder with delusions: preferred when delusions are documented
- •F14.251 — Cocaine dependence with cocaine-induced psychotic disorder with hallucinations: preferred when hallucinations are documented
- •F14.159 — Cocaine abuse with cocaine-induced psychotic disorder, unspecified: use when the pattern is abuse
- •F14.222 — Cocaine dependence with intoxication with perceptual disturbance: use for transient perceptual disturbance without full psychosis
- •F14.959 — Cocaine use, unspecified with cocaine-induced psychotic disorder, unspecified: use when abuse vs. dependence is unclear