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F16.19 ICD-10-CM Code: Hallucinogen abuse with unspecified hallucinogen-induced disorder

F16.19 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software

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Code lookupF16.19

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)

F16.19

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

Hallucinogen abuse with unspecified hallucinogen-induced disorder

Misuse of hallucinogenic drugs with psychiatric or medical complications that are not further specified or detailed.

Buddy the Bee presenting code insight

Buddy Insight

This unspecified code indicates hallucinogen abuse with an induced disorder that is not further characterized.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

HCC 137

Coefficient HCC 137: 0.424 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 082

Code-level coefficient reference

ESRD/PACE

HCC 55

Code-level coefficient reference

RXHCC

N/A

—

Not mapped

Code Book Path

Official
F16Hallucinogen related disordersF16.1Hallucinogen abuseF16.19Hallucinogen abuse with unspecified hallucinogen-induced disorder

Inclusion Terms

Official

No inclusion terms are included in this display for F16.19. 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

Official
F16.10Hallucinogen abuse, uncomplicatedF16.11Hallucinogen abuse, in remissionF16.12Hallucinogen abuse with intoxicationF16.14Hallucinogen abuse with hallucinogen-induced mood disorderF16.15Hallucinogen abuse with hallucinogen-induced psychotic disorder

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

Official

No Code First sequencing instructions are included in this display for F16.19. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F16.19. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F16.19. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
Provider statement confirming hallucinogen abuse
Documentation that an induced disorder is present even if unspecified
Evidence that a query was sent to the provider for clarification of the specific disorder
Clinical signs and symptoms observed during the encounter

MEAT Support

HCC Buddy guidance
Provider statement confirming hallucinogen abuse
Documentation that an induced disorder is present even if unspecified
Evidence that a query was sent to the provider for clarification of the specific disorder
Clinical signs and symptoms observed during the encounter

Audit Caution

HCC Buddy guidance
Defaulting to unspecified when sufficient documentation exists for a more specific code
Not querying the provider for additional detail about the induced disorder
Using this code when the patient actually meets criteria for dependence rather than abuse
Missing an opportunity to capture the specific induced disorder which may map to a higher-weighted HCC

Common Mistakes

HCC Buddy guidance
F16.10 — Hallucinogen abuse, uncomplicated; use when NO induced disorder is present
F16.188 — Hallucinogen abuse with other specified induced disorder; preferred when the disorder is identified
F16.14 — Hallucinogen abuse with mood disorder; use when mood symptoms are the documented complication
F16.99 — Hallucinogen use, unspecified with unspecified induced disorder; use when abuse vs dependence is unclear

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 F16.19 an HCC code?

Yes. F16.19 (Hallucinogen abuse with unspecified hallucinogen-induced disorder) maps to HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-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: F16.19 is billable and maps to V28 HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
F16.19
Description
Hallucinogen abuse with unspecified hallucinogen-induced disorder
HCC (V28)
HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
RAF reference coefficient
0.424
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
0.424
ESRDHCC 55, Substance Use Disorder/Moderate/Severe/Substance Use with Complications
Not separately weighted

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 F16.19 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F16.19

For F16.19, 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

F16.19 is the ICD-10-CM diagnosis code for hallucinogen abuse with unspecified hallucinogen-induced disorder. Misuse of hallucinogenic drugs with psychiatric or medical complications that are not further specified or detailed. F16.19 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, F16.19 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a source-labeled community, non-dual, aged reference coefficient of 0.424. 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.

This is the least specific code in the hallucinogen abuse category; use only when no other code applies. For F16.19, 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 F16.19 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •This is the least specific code in the hallucinogen abuse category; use only when no other code applies
  • •Query the provider to determine if a more specific hallucinogen-induced disorder code can be assigned

Clinical Significance

This unspecified code indicates hallucinogen abuse with an induced disorder that is not further characterized. While it still maps to risk-adjusting HCCs, it represents a missed opportunity for specificity. Clinically, it signals a patient needing substance abuse treatment with psychiatric comorbidity that requires further evaluation.

Documentation Requirements

  • ✓Provider statement confirming hallucinogen abuse
  • ✓Documentation that an induced disorder is present even if unspecified
  • ✓Evidence that a query was sent to the provider for clarification of the specific disorder
  • ✓Clinical signs and symptoms observed during the encounter
  • ✓Any screening tools or assessments performed

Commonly Confused Codes

  • •F16.10: Hallucinogen abuse, uncomplicated; use when NO induced disorder is present
  • •F16.188: Hallucinogen abuse with other specified induced disorder; preferred when the disorder is identified
  • •F16.14: Hallucinogen abuse with mood disorder; use when mood symptoms are the documented complication
  • •F16.99: Hallucinogen use, unspecified with unspecified induced disorder; use when abuse vs dependence is unclear

Child Codes

F16.10Hallucinogen abuse, uncomplicated
HCC 138
F16.11Hallucinogen abuse, in remission
HCC 138
F16.12Hallucinogen abuse with intoxication
F16.14Hallucinogen abuse with hallucinogen-induced mood disorder
HCC 137
F16.15Hallucinogen abuse with hallucinogen-induced psychotic disorder
F16.18Hallucinogen abuse with other hallucinogen-induced disorder
F16.19Hallucinogen abuse with unspecified hallucinogen-induced disorder
HCC 137

Code Hierarchy

└F16Hallucinogen related disorders└F16.1Hallucinogen abuse└F16.19Hallucinogen abuse with unspecified hallucinogen-induced disorder
└F16.19Hallucinogen abuse with unspecified hallucinogen-induced disorder

Also searched as

  • F16 19
  • F1619

For F16.19, 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.

F16.19 maps to CMS-HCC V28 category 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for F16.19. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

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Open F16.19 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

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