F19.159

HCC Category Mapping

What This Code Means

A condition where someone abuses multiple drugs and develops psychotic symptoms (such as delusions or hallucinations) that are caused by the substance, but the specific type is not documented.

Coding Tips

• •Use this code only when the specific psychotic features (delusions vs. hallucinations) are not clearly documented
• •Query the provider for clarification if possible to assign a more specific code

Clinical Significance

This code captures substance-induced psychotic disorder, which represents a serious psychiatric complication of other psychoactive substance abuse. Substance-induced psychosis significantly increases healthcare utilization, emergency department visits, and hospitalization risk, making accurate capture critical for risk adjustment. These patients require intensive psychiatric management and close monitoring for progression to chronic psychotic disorders.

Documentation Requirements

• ✓Provider documentation specifying the psychoactive substance(s) involved (e.g., designer drugs, bath salts, kratom, polysubstance use)
• ✓Clinical documentation supporting substance abuse pattern (maladaptive use pattern causing clinically significant impairment) without meeting criteria for dependence
• ✓Documentation of psychotic symptoms (delusions and/or hallucinations) with provider statement that they are substance-induced rather than a primary psychotic disorder
• ✓Assessment and plan addressing the substance use disorder with treatment approach documented

Commonly Confused Codes