F16.188
BillableHallucinogen abuse with other hallucinogen-induced disorder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F16.188 an HCC code?
Yes. F16.188 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications under the CMS-HCC V28 risk adjustment model (and Substance Use Disorder, Moderate/Severe, or Substance Use with Complications 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 F16.188
For F16.188to 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 F16.188 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F16.188 is the ICD-10-CM diagnosis code for hallucinogen abuse with other hallucinogen-induced disorder. Misuse of hallucinogenic drugs causing other psychiatric or medical complications not specified in other codes. F16.188 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, F16.188 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a community, non-dual, aged base RAF weight of 0.424. Under the older CMS-HCC V24 model, F16.188 maps to Substance Use Disorder, Moderate/Severe, or Substance Use with Complications (HCC 55) with a community, non-dual, aged base RAF weight of 0.329. 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.
Use this code for hallucinogen-induced disorders such as mood disorders, sleep disorders, or sexual dysfunction. Because F16.188 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 F16.188 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code for hallucinogen-induced disorders such as mood disorders, sleep disorders, or sexual dysfunction
- •Document the specific hallucinogen-induced condition in the medical record for clarity
Clinical Significance
Hallucinogen abuse with other induced disorders captures psychiatric or medical complications beyond the standard categories (psychosis, mood, anxiety). This is important for risk adjustment because it signals a patient with active substance abuse and additional comorbid conditions that increase care complexity and resource utilization.
Documentation Requirements
- ✓Provider documentation of hallucinogen abuse (pattern of maladaptive use)
- ✓Specific identification of the induced disorder (e.g., sleep disorder, sexual dysfunction)
- ✓Causal link stated between the hallucinogen use and the induced condition
- ✓Type of hallucinogen used when known (LSD, psilocybin, MDMA-related)
- ✓Current treatment plan addressing both the abuse and the induced disorder
Commonly Confused Codes
- •F16.19 — Hallucinogen abuse with unspecified induced disorder; use F16.188 when the disorder IS specified but does not fit mood, psychotic, or anxiety categories
- •F16.14 — Hallucinogen abuse with induced mood disorder; use when mood disorder specifically is the complication
- •F16.288 — Hallucinogen dependence with other induced disorder; use when dependence rather than abuse is documented
- •F16.180 — Hallucinogen abuse with induced anxiety disorder; use when anxiety is the specific complication