What is ICD-10 code F19.188?

F19.188 is the ICD-10-CM diagnosis code for Other psychoactive substance abuse with other psychoactive substance-induced disorder. A person who abuses multiple types of psychoactive substances and has other mental or physical health problems caused by the substance use. F19.188 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F19.188 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F19.188 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F19.188 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does F19.188 map to under V28?

F19.188 maps to CMS-HCC V28 HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM F19.188: Other psychoactive

F19.188 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

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Code lookupF19.188Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)

F19.188

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Other psychoactive substance abuse with other psychoactive substance-induced disorder

A person who abuses multiple types of psychoactive substances and has other mental or physical health problems caused by the substance use.

Buddy Insight

This code captures other specified substance-induced disorders from other psychoactive substance abuse that do not fit into the standard categories of psychosis, mood, anxiety, or sleep disorders.

CMS-HCC V28

Mapped

HCC 137

Drug Use Disorder, Moderate/S...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 082

HHS-HCC 082 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 55

Substance Use Disorder/Modera...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F19.1Other psychoactive substance abuse

F19.18Other psychoactive substance abuse with other psychoactive substance-induced disorders

F19.188Other psychoactive substance abuse with other psychoactive substance-induced disorder

Inclusion Terms

Official

Other (or unknown) substance use disorder, mild, with other (or unknown) substance induced mild neurocognitive disorder
Other (or unknown) substance use disorder, mild, with other (or unknown) substance induced obsessive-compulsive or related disorder

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F19.188 in this effective period.

Related Child Codes

Official

F19.180Other psychoactive substance abuse with psychoactive substance-induced anxiety disorder

F19.181Other psychoactive substance abuse with psychoactive substance-induced sexual dysfunction

F19.182Other psychoactive substance abuse with psychoactive substance-induced sleep disorder

Includes

Official

ICD-10-CM does not list Includes notes for F19.188 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F19.188 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F19.188 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F19.188 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F19.188 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

Description of the specific substance-induced disorder that does not fit standard categories (e.g., movement disorder, olfactory disorder, obsessive-compulsive features)

Assessment and plan addressing the substance use disorder with treatment approach documented

MEAT Support

HCC Buddy guidance

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

Description of the specific substance-induced disorder that does not fit standard categories (e.g., movement disorder, olfactory disorder, obsessive-compulsive features)

Assessment and plan addressing the substance use disorder with treatment approach documented

Audit Caution

HCC Buddy guidance

Using F19 codes when a more specific substance category exists — always check if the substance is better classified under F10 (alcohol), F11 (opioids), F12 (cannabis), F13 (sedatives), F14 (cocaine), F15 (stimulants), F16 (hallucinogens), or F18 (inhalants)

Coding abuse when documentation supports dependence — the DSM-5 uses 'substance use disorder' with severity levels; ICD-10 still distinguishes abuse from dependence, requiring careful mapping

Not documenting the encounter as addressing the substance use disorder in the assessment and plan — the condition must be actively managed or monitored during the visit to support coding

Common Mistakes

HCC Buddy guidance

F19.20-F19.29 (Other psychoactive substance dependence) — dependence indicates a more severe pattern with tolerance, compulsive use, or withdrawal; abuse is a less severe use pattern

F19.90-F19.99 (Other psychoactive substance use, unspecified) — unspecified use is used when abuse vs. dependence is not documented

F10-F16 (Specific substance codes: alcohol, opioids, cannabis, sedatives, cocaine, stimulants) — use substance-specific codes when the substance is identified; F19 is for 'other' or multiple unspecified substances

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is F19.188 an HCC code?

Yes. F19.188 (Other psychoactive substance abuse with other psychoactive substance-induced disorder) maps to HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.424. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: F19.188 is billable and maps to V28 HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F19.188
Description: Other psychoactive substance abuse with other psychoactive substance-induced disorder
HCC (V28): HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
RAF reference coefficient: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications

0.424

ESRDHCC 55, Substance Use Disorder/Moderate/Severe/Substance Use with Complications

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work F19.188 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for F19.188

For F19.188 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed F19.188 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F19.188 is the ICD-10-CM diagnosis code for other psychoactive substance abuse with other psychoactive substance-induced disorder. A person who abuses multiple types of psychoactive substances and has other mental or physical health problems caused by the substance use. F19.188 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering mental and behavioral disorders due to psychoactive substance use (f10-f19).

Under the CMS-HCC V28 risk adjustment model, F19.188 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a source-labeled community, non-dual, aged reference coefficient of 0.424. No V24 mapping is shown for F19.188; use the applicable model and payment year when reviewing the V28 mapping. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Specify the type of induced disorder (mood, anxiety, psychotic, etc.) in clinical documentation. Because F19.188 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for F19.188 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Specify the type of induced disorder (mood, anxiety, psychotic, etc.) in clinical documentation
•Link the disorder directly to the substance abuse in the medical record

Clinical Significance

This code captures other specified substance-induced disorders from other psychoactive substance abuse that do not fit into the standard categories of psychosis, mood, anxiety, or sleep disorders. These may include movement disorders, neurocognitive changes, or other organ-specific complications. Accurate coding of these additional complications reflects the true clinical burden and supports appropriate risk adjustment.

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
✓Description of the specific substance-induced disorder that does not fit standard categories (e.g., movement disorder, olfactory disorder, obsessive-compulsive features)
✓Assessment and plan addressing the substance use disorder with treatment approach documented

Commonly Confused Codes

•F19.20-F19.29 (Other psychoactive substance dependence): dependence indicates a more severe pattern with tolerance, compulsive use, or withdrawal; abuse is a less severe use pattern
•F19.90-F19.99 (Other psychoactive substance use, unspecified): unspecified use is used when abuse vs. dependence is not documented
•F10-F16 (Specific substance codes: alcohol, opioids, cannabis, sedatives, cocaine, stimulants): use substance-specific codes when the substance is identified; F19 is for 'other' or multiple unspecified substances