F16.99
BillableHallucinogen use, unspecified with unspecified hallucinogen-induced disorder
HCC Category Mapping
V28HCC 137 — Drug Use Disorder/Substance Use Disorder, Moderate/Severe
0.358V24HCC 55 — Drug/Alcohol Dependence
0.334ESRDHCC 55 — Drug/Alcohol Dependence
0.000What This Code Means
A condition involving unspecified hallucinogenic drug use with unspecified health problems caused by the drug, where neither the specific hallucinogen nor the specific disorder is clearly identified.
Coding Tips
- •This is the least specific hallucinogen use code; use only when documentation lacks detail about both the substance and induced disorder
- •Query the provider if more specific information about the hallucinogen type or induced disorder can be documented
Clinical Significance
This is the least specific hallucinogen use code — unspecified use pattern with unspecified induced disorder. It indicates significant documentation gaps in both the substance use pattern and the nature of complications. While it still captures HCC value, it represents the lowest quality coding in this category.
Documentation Requirements
- ✓Minimum documentation of hallucinogen use with some induced disorder
- ✓Provider queries for both the use pattern and specific disorder type
- ✓Clinical justification for why specificity cannot be achieved
- ✓Follow-up plan for comprehensive substance use evaluation
- ✓Any available clinical signs or symptoms documented
Commonly Confused Codes
F16.90 — Hallucinogen use, unspecified, uncomplicated; use when NO induced disorder existsF16.988 — With other specified induced disorder; preferred when the disorder IS identifiedF16.959 — With psychotic disorder; if psychosis exists, this code captures higher HCC valueF16.29 — Hallucinogen dependence with unspecified disorder; more specific regarding dependence
Code Hierarchy
└F16Hallucinogen related disorders└F16.9Hallucinogen use, unspecified└F16.99Hallucinogen use, unspecified with unspecified hallucinogen-induced disorder
└F16.99Hallucinogen use, unspecified with unspecified hallucinogen-induced disorder