F16.259
BillableHallucinogen dependence with hallucinogen-induced psychotic disorder, unspecified
HCC Category Mapping
V28HCC 135 — Drug/Alcohol Psychosis
0.000V24HCC 54 — Drug/Alcohol Psychosis
0.434ESRDHCC 54 — Drug/Alcohol Psychosis
0.000What This Code Means
A person dependent on hallucinogenic drugs is experiencing psychosis (loss of touch with reality) caused by the hallucinogen use, but the specific features are not detailed.
Coding Tips
- •Use this code when hallucinogen-induced psychotic disorder is documented but hallucinations are not specifically mentioned
- •Query the provider to determine if hallucinations are present to potentially use the more specific F16.251
Clinical Significance
This unspecified psychotic disorder code captures hallucinogen-induced psychosis when the documentation does not clarify whether delusions or hallucinations predominate. It still maps to the higher-weighted psychosis HCC but represents a documentation improvement opportunity.
Documentation Requirements
- ✓Documentation of hallucinogen dependence
- ✓Evidence of psychotic symptoms linked to hallucinogen use
- ✓Provider query for specific psychotic features (delusions vs hallucinations)
- ✓Mental status examination supporting psychotic disorder diagnosis
- ✓Treatment plan addressing psychotic symptoms
Commonly Confused Codes
F16.250 — With delusions; preferred when delusions are documentedF16.251 — With hallucinations; preferred when hallucinations are documentedF16.29 — Hallucinogen dependence with unspecified induced disorder; does NOT capture psychosis specificallyF16.959 — Hallucinogen use, unspecified with psychotic disorder, unspecified; even less specific
Code Hierarchy
└F16Hallucinogen related disorders└F16.2Hallucinogen dependence└F16.25Hallucinogen dependence with hallucinogen-induced psychotic disorder└F16.259Hallucinogen dependence with hallucinogen-induced psychotic disorder, unspecified
└F16.259Hallucinogen dependence with hallucinogen-induced psychotic disorder, unspecified