F19.959 ICD-10-CM Code: Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified
F19.959 maps to CMS-HCC V28 135. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)
F19.959
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified
This code describes a patient who uses unspecified psychoactive substances (drugs or alcohol) and has developed psychotic symptoms like hallucinations or delusions as a direct result of that substance use. The specific substance and type of psychotic disorder are not identified.
Buddy Insight
Other psychoactive substance use, unspecified with substance-induced psychotic disorder, unspecified captures a psychotic presentation caused by substance use where the specific psychotic features (delusions vs.
CMS-HCC V28
MappedHCC 135
Coefficient HCC 135: 0.424 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 081
Code-level coefficient reference
ESRD/PACE
MappedHCC 54
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Other or unknown substance-induced psychotic disorder, without use disorder
Excludes 2
Official- symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99
Related Codes
Includes
Official- disorders of psychological developmentInherited from F01-F99, F19
- polysubstance drug use (indiscriminate drug use)Inherited from F01-F99, F19
Excludes 1
Official- other psychoactive substance abuse (F19.1-)Inherited from F19.9
- other psychoactive substance dependence (F19.2-)Inherited from F19.9
Code First
OfficialNo Code First sequencing instructions are included in this display for F19.959. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F19.959. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F19.959. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 F19.959 an HCC code?
Yes. F19.959 (Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified) maps to HCC 135, Drug Use with 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: F19.959 is billable and maps to V28 HCC 135, Drug Use with Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- F19.959
- Description
- Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified
- HCC (V28)
- HCC 135 — Drug Use with Psychotic Complications
- RAF reference coefficient
- 0.424
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 F19.959 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F19.959
For F19.959, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
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What This Code Means
F19.959 is the ICD-10-CM diagnosis code for other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified. This code describes a patient who uses unspecified psychoactive substances (drugs or alcohol) and has developed psychotic symptoms like hallucinations or delusions as a direct result of that substance use. The specific substance and type of psychotic disorder are not identified. F19.959 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, F19.959 maps to Drug Use with Psychotic Complications (HCC 135) with a source-labeled community, non-dual, aged reference coefficient of 0.424. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. 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.
Use this code only when the specific psychoactive substance cannot be identified; if the substance is known (cocaine, cannabis, opioids, etc.), use the more specific F1X.959 code for that substance. For F19.959, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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 F19.959 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the specific psychoactive substance cannot be identified; if the substance is known (cocaine, cannabis, opioids, etc.), use the more specific F1X.959 code for that substance
- •Ensure documentation clearly links the psychotic symptoms to active substance use rather than a primary psychotic disorder; if psychosis persists after substance cessation, a different diagnosis may be more appropriate
Clinical Significance
Other psychoactive substance use, unspecified with substance-induced psychotic disorder, unspecified captures a psychotic presentation caused by substance use where the specific psychotic features (delusions vs. hallucinations) are not documented. While less specific than F19.950 or F19.951, it still maps to the higher psychosis HCC. This code represents a documentation opportunity — querying the provider about the specific psychotic features would improve clinical data quality.
Documentation Requirements
- ✓Documentation of psychoactive substance use with temporal relationship to psychosis
- ✓Provider statement that psychotic symptoms are substance-induced
- ✓Attempt to clarify whether primary features are delusions, hallucinations, or both through provider query
- ✓Safety assessment and level of care determination
- ✓Psychiatric evaluation documentation
- ✓Treatment plan including psychotropic medications if used
Commonly Confused Codes
- •F19.950: Use when DELUSIONS are the primary psychotic feature
- •F19.951: Use when HALLUCINATIONS are the primary psychotic feature
- •F29: Unspecified psychosis not due to substance; use only when substance etiology is ruled out
- •F19.929: Intoxication, unspecified does NOT capture the psychotic disorder component
- •F19.99: Unspecified substance-induced disorder is even less specific and misses the psychosis designation