F19.959

HCC Category Mapping

What This Code Means

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.

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