F16.920

HCC Category Mapping

What This Code Means

This code describes a person using hallucinogenic drugs (such as LSD or psilocybin) in an unspecified pattern, currently experiencing intoxication without serious complications. The intoxication is uncomplicated, meaning there are no severe medical or psychiatric emergencies present at this time.

Coding Tips

• •Use this code only when the hallucinogen use pattern is not specified as continuous, episodic, or in remission; if the pattern is known, select the appropriate 5th character (1=continuous, 2=episodic, 3=in remission)
• •Verify that intoxication is truly 'uncomplicated' before assigning this code; if there are complications such as delirium, perceptual disturbances, or other medical/psychiatric effects, use a different code from the F16.92x series

Clinical Significance

This code captures hallucinogen use (unspecified pattern) with uncomplicated intoxication. The 'unspecified use' designation means the provider has not documented whether the pattern meets criteria for abuse or dependence. While it still maps to HCCs, the unspecified nature limits clinical utility and may trigger compliance reviews.

Documentation Requirements

• ✓Documentation of hallucinogen use and current intoxication
• ✓Clinical signs of intoxication without delirium
• ✓Provider query to determine if abuse or dependence criteria are met
• ✓Vital signs and mental status examination
• ✓Assessment of complications or induced disorders

Commonly Confused Codes