F19.19 ICD-10-CM Code: Other psychoactive substance abuse with unspecified psychoactive substance-induced disorder
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)
F19.19
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther psychoactive substance abuse with unspecified psychoactive substance-induced disorder
A person who abuses psychoactive substances and has an unspecified mental or physical health problem 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
MappedHCC 137
RAF 0.358
CMS-HCC V24
MappedHCC 55
RAF 0.334
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 55
RAF 0.0
RXHCC
00
RAF 0
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for F19.19 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for F19.19 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for F19.19 in this effective period.
Excludes 1
Official- other psychoactive substance dependence (F19.2-)
- other psychoactive substance use, unspecified (F19.9-)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for F19.19 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for F19.19 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for F19.19 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is F19.19 an HCC code?
Yes. F19.19 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Dependence under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
Work F19.19 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for F19.19
For F19.19to 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 F19.19 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
Get the V28 RAF + MEAT cheat sheet
One printable page: confirm a code's V28 HCC status, its RAF weight, and the MEAT your note needs to make it stick. Free, no card.
Free PDF. No card. Unsubscribe anytime.
What This Code Means
F19.19 is the ICD-10-CM diagnosis code for other psychoactive substance abuse with unspecified psychoactive substance-induced disorder. A person who abuses psychoactive substances and has an unspecified mental or physical health problem caused by the substance use. F19.19 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, F19.19 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe (HCC 137) with a community, non-dual, aged base RAF weight of 0.358. Under the older CMS-HCC V24 model, F19.19 maps to Drug/Alcohol Dependence (HCC 55) with a community, non-dual, aged base RAF weight of 0.334. 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.
Use only when the specific induced disorder cannot be determined from documentation. Because F19.19 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, and MEAT documentation criteria for F19.19 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use only when the specific induced disorder cannot be determined from documentation
- •Query provider for clarification on the type of substance-induced disorder when possible
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