F19.97 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 · HCC coding software

ICD-10-CM Code View

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Code lookupF19.97

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)

F19.97

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Other psychoactive substance use, unspecified with psychoactive substance-induced persisting dementia

A progressive decline in thinking, memory, and daily functioning that persists as a lasting consequence of psychoactive substance use.

Buddy Insight

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 135

Drug Use with Psychotic Compl...

Coefficient HCC 135: 0.424 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 081

HHS-HCC 081 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 54

Substance Use with Psychotic ...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F19Other psychoactive substance related disorders F19.9Other psychoactive substance use, unspecified F19.97Other psychoactive substance use, unspecified with psychoactive substance-induced persisting dementia

Inclusion Terms

Official

Other (or unknown) substance-induced major neurocognitive 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

Official

F19.90Other psychoactive substance use, unspecified, uncomplicated F19.91Other psychoactive substance use, unspecified, in remission F19.92Other psychoactive substance use, unspecified with intoxication F19.93Other psychoactive substance use, unspecified with withdrawal F19.94Other psychoactive substance use, unspecified with psychoactive substance-induced mood disorder

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

Official

No Code First sequencing instructions are included in this display for F19.97. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F19.97. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F19.97. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of current or historical psychoactive substance use

Comprehensive cognitive assessment demonstrating deficits in multiple domains (memory, executive function, language, visuospatial)

Provider determination that dementia is substance-induced and not due to neurodegenerative disease

Functional impact assessment showing decline from prior baseline

MEAT Support

HCC Buddy guidance

Documentation of current or historical psychoactive substance use

Comprehensive cognitive assessment demonstrating deficits in multiple domains (memory, executive function, language, visuospatial)

Provider determination that dementia is substance-induced and not due to neurodegenerative disease

Functional impact assessment showing decline from prior baseline

Audit Caution

HCC Buddy guidance

Coding unspecified dementia (F03.90) when documentation clearly establishes substance use as the cause

Confusing substance-induced persisting dementia with acute cognitive effects during intoxication or withdrawal

Not capturing this code when cognitive decline is documented in the context of extensive substance use history

Using amnestic disorder codes (F19.96) when the cognitive decline extends beyond memory to include executive function, language, or other domains

Common Mistakes

HCC Buddy guidance

F10.97 — ALCOHOL-induced persisting dementia; use when alcohol is the specific substance

F19.96 — Substance-induced persisting AMNESTIC DISORDER is limited to memory; dementia is broader cognitive decline

F03.90 — Unspecified dementia should not be used when the substance-induced etiology is established

G31.2 — Degeneration of nervous system due to alcohol is a different classification

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 F19.97 an HCC code?

Yes. F19.97 (Other psychoactive substance use, unspecified with psychoactive substance-induced persisting dementia) 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: F19.97 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: F19.97
Description: Other psychoactive substance use, unspecified with psychoactive substance-induced persisting dementia
HCC (V28): HCC 135 — Drug Use with Psychotic Complications
RAF reference coefficient: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 135, Drug Use with Psychotic Complications

0.424

ESRDHCC 54, Substance Use with Psychotic Complications

Not separately weighted

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 F19.97 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F19.97

For F19.97, 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

Coder workflow notes

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What This Code Means

F19.97 is the ICD-10-CM diagnosis code for other psychoactive substance use, unspecified with psychoactive substance-induced persisting dementia. A progressive decline in thinking, memory, and daily functioning that persists as a lasting consequence of psychoactive substance use. F19.97 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, F19.97 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.

Differentiate between substance-induced persisting dementia and primary neurodegenerative dementias. For F19.97, 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 F19.97 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Differentiate between substance-induced persisting dementia and primary neurodegenerative dementias
•Document cognitive testing results and functional decline timeline

Clinical Significance

Other psychoactive substance use, unspecified with substance-induced persisting dementia represents a progressive and lasting decline in multiple cognitive domains (memory, reasoning, language, executive function) caused by substance use. This is among the most severe long-term consequences of substance abuse and requires extensive ongoing care. The 'persisting' designation indicates permanent brain damage that continues after substance cessation, significantly impacting the patient's ability to function independently.

Documentation Requirements

✓Documentation of current or historical psychoactive substance use
✓Comprehensive cognitive assessment demonstrating deficits in multiple domains (memory, executive function, language, visuospatial)
✓Provider determination that dementia is substance-induced and not due to neurodegenerative disease
✓Functional impact assessment showing decline from prior baseline
✓Neuroimaging findings when available (cerebral atrophy, white matter disease)
✓Assessment of the patient's capacity for self-care and decision-making

Commonly Confused Codes

•F10.97: ALCOHOL-induced persisting dementia; use when alcohol is the specific substance
•F19.96: Substance-induced persisting AMNESTIC DISORDER is limited to memory; dementia is broader cognitive decline
•F03.90: Unspecified dementia should not be used when the substance-induced etiology is established
•G31.2: Degeneration of nervous system due to alcohol is a different classification
•F01.50: Vascular dementia should be used when the etiology is cerebrovascular, not substance-related