F15.259

HCC Category Mapping

What This Code Means

A person who is dependent on stimulant drugs (like cocaine or amphetamines) and is experiencing psychotic symptoms such as hallucinations or delusions as a direct result of the drug use.

Coding Tips

• •Document whether the psychotic disorder is with or without hallucinations/delusions to support medical necessity
• •Verify the stimulant type (cocaine, amphetamine, other) is documented to ensure accurate coding of the primary substance

Clinical Significance

Stimulant dependence with unspecified psychotic disorder indicates psychotic features are present but not further characterized as delusions or hallucinations. While this still maps to the highest substance use HCC, it reflects incomplete documentation that should prompt a provider query. Specifying the psychotic manifestation supports better clinical care and stronger audit defensibility.

Documentation Requirements

• ✓Documented stimulant dependence
• ✓Evidence of psychotic symptoms attributed to stimulant use
• ✓Query to provider to specify whether delusions, hallucinations, or both are present
• ✓Documentation that psychosis is substance-induced
• ✓Treatment plan addressing the psychotic disorder and underlying dependence

Commonly Confused Codes