F19.232
BillableOther psychoactive substance dependence with withdrawal with perceptual disturbance
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F19.232 an HCC code?
Yes. F19.232 maps to Drug/Alcohol Psychosis under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Psychosis 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.
MEAT Criteria for F19.232
For F19.232 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 F19.232 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F19.232 is the ICD-10-CM diagnosis code for other psychoactive substance dependence with withdrawal with perceptual disturbance. Addiction to various drugs or substances with withdrawal symptoms that include seeing, hearing, or feeling things that aren't real. F19.232 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, F19.232 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F19.232 mapped to the same category but with a base RAF weight of 0.434 — V28 recalibrated weights across the entire model. 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.
Document the specific substance(s) involved when possible, as this may affect treatment planning. Because F19.232 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 F19.232 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific substance(s) involved when possible, as this may affect treatment planning
- •Ensure withdrawal symptoms with perceptual disturbance are clearly documented in the clinical record to distinguish from other withdrawal presentations
Clinical Significance
This code captures withdrawal with perceptual disturbances from other psychoactive substance dependence, indicating hallucination-like experiences during substance cessation. While less severe than full delirium, perceptual disturbances during withdrawal signal significant physiological dependence and risk for progression to more severe withdrawal complications. Accurate capture supports appropriate risk stratification and treatment planning.
Documentation Requirements
- ✓Provider documentation specifying the psychoactive substance(s) involved (e.g., designer drugs, bath salts, kratom, polysubstance use)
- ✓Clinical documentation supporting dependence criteria: tolerance, withdrawal symptoms, compulsive use despite harm, or inability to control use
- ✓Documentation of withdrawal symptoms temporally related to cessation or reduction of substance use
- ✓Documentation of perceptual disturbances during withdrawal (hallucinations, illusions, or misperceptions) with the patient recognizing them as substance-related
- ✓Assessment and plan addressing the substance use disorder with treatment approach documented
Commonly Confused Codes
- •F19.10-F19.19 (Other psychoactive substance abuse) — abuse indicates a less severe use pattern without meeting dependence criteria
- •F19.90-F19.99 (Other psychoactive substance use, unspecified) — unspecified use is used when the severity of the use disorder is not documented
- •F19.231 (Withdrawal delirium) — delirium represents a more severe condition with global cognitive disruption and autonomic instability
- •F19.230 (Withdrawal, uncomplicated) — uncomplicated withdrawal lacks perceptual disturbances
- •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