F22 ICD-10-CM Code: Delusional disorders
F22 maps to CMS-HCC V28 152. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F20-F29)
F22
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceDelusional disorders
A mental health condition where a person holds one or more non-bizarre delusions (beliefs that could theoretically be true) for at least one month, without other prominent psychotic symptoms.
Buddy Insight
Delusional disorders are characterized by one or more non-bizarre delusions lasting at least one month, without the other prominent psychotic features seen in schizophrenia.
CMS-HCC V28
MappedHCC 152
Coefficient HCC 152: 0.484 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
Context neededHCC 087_2
Coefficient needs member context
ESRD/PACE
Context neededHCC 59
Coefficient needs member context
RXHCC
MappedHCC 133
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Delusional dysmorphophobia
- Involutional paranoid state
- Paranoia
- Paranoia querulans
- Paranoid psychosis
- Paranoid state
- Paraphrenia (late)
- Sensitiver Beziehungswahn
Excludes 2
Official- paranoid personality disorder (F60.0)
- paranoid psychosis, psychogenic (F23)
- paranoid reaction (F23)
- symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99
Related Codes
No related codes are included in this display for F22. Check the Code Book for the complete code path.
Includes
Official- disorders of psychological developmentInherited from F01-F99
Excludes 1
Official- mood [affective] disorders with psychotic symptoms (F30.2, F31.2, F31.5, F31.64, F32.3, F33.3)
- paranoid schizophrenia (F20.0)
Code First
OfficialNo Code First sequencing instructions are included in this display for F22. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F22. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F22. 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 F22 an HCC code?
Yes. F22 (Delusional disorders) maps to HCC 152, Psychosis, Except Schizophrenia under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.484. 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: F22 is billable and maps to V28 HCC 152, Psychosis, Except Schizophrenia. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- F22
- Description
- Delusional disorders
- HCC (V28)
- HCC 152 — Psychosis, Except Schizophrenia
- RAF reference coefficient
- 0.484
- 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 F22 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F22
For F22, 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
F22 is the ICD-10-CM diagnosis code for delusional disorders. A mental health condition where a person holds one or more non-bizarre delusions (beliefs that could theoretically be true) for at least one month, without other prominent psychotic symptoms. F22 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (f20-f29).
Under the CMS-HCC V28 risk adjustment model, F22 maps to Psychosis, Except Schizophrenia (HCC 152) with a source-labeled community, non-dual, aged reference coefficient of 0.484. 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.
Confirm delusions are non-bizarre and have persisted for at least one month. For F22, 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 F22 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm delusions are non-bizarre and have persisted for at least one month
- •Verify that hallucinations are not prominent and functioning is relatively preserved outside the delusional content
Clinical Significance
Delusional disorders are characterized by one or more non-bizarre delusions lasting at least one month, without the other prominent psychotic features seen in schizophrenia. The delusions may be persecutory, grandiose, jealous, erotomanic, or somatic. Unlike schizophrenia, functioning is relatively preserved outside the delusional content. This distinction is clinically important and affects both treatment approach and risk adjustment, as delusional disorder maps to a different HCC than schizophrenia.
Documentation Requirements
- ✓Documented diagnosis of delusional disorder by a qualified mental health professional
- ✓Description of the specific type of delusion(s) present (persecutory, grandiose, jealous, erotomanic, somatic, mixed)
- ✓Duration of delusions documented as at least one month
- ✓Assessment confirming absence of other prominent psychotic features (hallucinations should be absent or minimal)
- ✓Documentation that overall functioning is relatively intact outside the delusional content
- ✓Treatment plan and medication regimen
Excludes 1, Do NOT code together
Excludes 2, Not included here, may code separately
Commonly Confused Codes
- •F20.0: Paranoid schizophrenia has broader psychotic features beyond delusions alone
- •F23: Brief psychotic disorder lasts under one month; delusional disorder requires at least one month
- •F06.2: Psychotic disorder with delusions due to known physiological condition; rule out medical causes
- •F24: Shared psychotic disorder involves adoption of delusions from another person
- •F22 vs. F20: The key distinction is that delusional disorder lacks the disorganized behavior, negative symptoms, and prominent hallucinations of schizophrenia