F16.950
BillableHallucinogen use, unspecified with hallucinogen-induced psychotic disorder with delusions
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
This code describes a patient who uses hallucinogenic drugs (such as LSD or psilocybin) and has developed a psychotic disorder characterized by false beliefs (delusions) as a direct result of the drug use. The 'unspecified' portion indicates the pattern or frequency of hallucinogen use is not documented.
Coding Tips
- •Verify documentation clearly links the psychotic symptoms with delusions to hallucinogen use rather than a primary psychotic disorder; if the psychosis predates drug use, a different code may be appropriate
- •Confirm the specific hallucinogen type is not documented; if it is specified (e.g., LSD, psilocybin), use the more specific F16.1xx or F16.2xx codes instead of the 'unspecified' category
Clinical Significance
Hallucinogen use (unspecified) with induced psychotic disorder with delusions represents a serious psychiatric complication where hallucinogen use has triggered false fixed beliefs. Even with unspecified use pattern, this maps to the higher-weighted psychosis HCC, making accurate capture particularly important for risk adjustment.
Documentation Requirements
- ✓Documentation of hallucinogen use (pattern unspecified)
- ✓Specific documentation of delusions (types and content of false beliefs)
- ✓Provider statement linking psychotic symptoms to hallucinogen use
- ✓Mental status examination with psychosis findings
- ✓Differentiation from primary psychotic disorders
- ✓Provider query to clarify abuse vs dependence if possible
Commonly Confused Codes
F16.951 — With hallucinations; use when hallucinations predominateF16.250 — Hallucinogen dependence with psychotic disorder with delusions; preferred when dependence is documentedF16.150 — Hallucinogen abuse with psychotic disorder with delusions; preferred when abuse is documentedF22 — Delusional disorders; use for primary delusional disorder not substance-induced
Code Hierarchy
└F16Hallucinogen related disorders└F16.9Hallucinogen use, unspecified└F16.95Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder└F16.950Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with delusions
└F16.950Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with delusions