F19.922
BillableOther psychoactive substance use, unspecified with intoxication with perceptual disturbance
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F19.922 an HCC code?
Yes. F19.922 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.
MEAT Criteria for F19.922
For F19.922 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 F19.922 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F19.922 is the ICD-10-CM diagnosis code for other psychoactive substance use, unspecified with intoxication with perceptual disturbance. Current use of various psychoactive substances causing intoxication with visual, auditory, or tactile hallucinations or distorted perceptions. F19.922 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, F19.922 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, F19.922 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.
This code specifically indicates perceptual disturbances (hallucinations) during intoxication. Because F19.922 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 F19.922 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code specifically indicates perceptual disturbances (hallucinations) during intoxication
- •Document whether hallucinations are visual, auditory, or tactile for clinical clarity
Clinical Significance
Other psychoactive substance use, unspecified with intoxication with perceptual disturbance captures substance intoxication complicated by hallucinations or sensory distortions without full delirium. This presentation requires careful clinical monitoring as it may progress to a more severe state. The distinction between perceptual disturbances and delirium is clinically significant and affects treatment planning, making accurate coding essential for reflecting the complexity of care provided.
Documentation Requirements
- ✓Documentation of current intoxication from psychoactive substance(s)
- ✓Specific description of perceptual disturbances (visual, auditory, or tactile hallucinations; illusions; sensory distortions)
- ✓Confirmation that the perceptual disturbances are occurring in the context of intoxication, not withdrawal
- ✓Assessment that full delirium criteria are NOT met (otherwise code F19.921)
- ✓Clinical evaluation of the patient's insight into the perceptual disturbances
- ✓Substance identification when possible and safety assessment
Commonly Confused Codes
- •F19.921 — Intoxication WITH DELIRIUM represents a more severe state with global cognitive dysfunction, not just perceptual disturbances
- •F19.920 — Intoxication, UNCOMPLICATED should be used when no perceptual disturbances or delirium are present
- •F19.950 — Substance-induced PSYCHOTIC DISORDER with delusions is a separate condition from intoxication with perceptual disturbance
- •F19.951 — Substance-induced psychotic disorder with hallucinations is distinct because it represents a psychotic break, not simple intoxication effects