F16.159 ICD-10-CM Code: Hallucinogen abuse with hallucinogen-induced psychotic disorder, unspecified
F16.159 maps to CMS-HCC V28 135. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)
F16.159
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceHallucinogen abuse with hallucinogen-induced psychotic disorder, unspecified
Misuse of hallucinogenic drugs leading to a persistent psychotic disorder with unspecified psychotic features.
Buddy Insight
Hallucinogen abuse with unspecified psychotic disorder indicates psychotic features from hallucinogen abuse that are not further characterized as delusions or hallucinations.
CMS-HCC V28
MappedHCC 135
Coefficient HCC 135: 0.424 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 081
Code-level coefficient reference
ESRD/PACE
MappedHCC 54
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for F16.159. 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
Includes
Official- disorders of psychological developmentInherited from F01-F99, F16
- ecstasyInherited from F01-F99, F16
- PCPInherited from F01-F99, F16
- phencyclidineInherited from F01-F99, F16
Excludes 1
Official- hallucinogen dependence (F16.2-)Inherited from F16.1
- hallucinogen use, unspecified (F16.9-)Inherited from F16.1
Code First
OfficialNo Code First sequencing instructions are included in this display for F16.159. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F16.159. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F16.159. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 F16.159 an HCC code?
Yes. F16.159 (Hallucinogen abuse with hallucinogen-induced psychotic disorder, unspecified) maps to HCC 135, Drug Use with 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: F16.159 is billable and maps to V28 HCC 135, Drug Use with Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- F16.159
- Description
- Hallucinogen abuse with hallucinogen-induced psychotic disorder, unspecified
- HCC (V28)
- HCC 135 — Drug Use with Psychotic Complications
- RAF reference coefficient
- 0.424
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 F16.159 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F16.159
For F16.159, 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
F16.159 is the ICD-10-CM diagnosis code for hallucinogen abuse with hallucinogen-induced psychotic disorder, unspecified. Misuse of hallucinogenic drugs leading to a persistent psychotic disorder with unspecified psychotic features. F16.159 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, F16.159 maps to Drug Use with Psychotic Complications (HCC 135) with a source-labeled community, non-dual, aged reference coefficient of 0.424. No V24 mapping is shown for F16.159; use the applicable model and payment year when reviewing the V28 mapping. 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 when hallucinogen-induced psychotic disorder is documented but the specific psychotic features are not detailed. For F16.159, 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 F16.159 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when hallucinogen-induced psychotic disorder is documented but the specific psychotic features are not detailed
- •Attempt to obtain clarification on whether delusions, hallucinations, or other psychotic symptoms are present
Clinical Significance
Hallucinogen abuse with unspecified psychotic disorder indicates psychotic features from hallucinogen abuse that are not further characterized as delusions or hallucinations. While still mapping to the highest substance use HCC, this code represents a documentation gap. Provider queries should be initiated to specify the psychotic manifestation for stronger clinical documentation and audit defensibility.
Documentation Requirements
- ✓Documented hallucinogen abuse
- ✓Evidence of psychotic symptoms attributed to hallucinogen use
- ✓Query to provider to specify delusions vs. hallucinations
- ✓Documentation that psychosis is substance-induced and persists beyond expected intoxication effects
- ✓Psychiatric evaluation and treatment plan
Commonly Confused Codes
- •F16.150: Use when delusions are specifically documented
- •F16.151: Use when hallucinations are specifically documented
- •F16.122: Hallucinogen abuse with intoxication with perceptual disturbance; transient, not psychotic disorder
- •F16.259: Hallucinogen dependence with unspecified psychotic disorder; requires dependence documentation