F22
BillableDelusional disorders
HCC Category Mapping
V28HCC 152 — Delusional and Other Specified Psychotic Disorders
0.546V24HCC 59 — Major Depressive, Bipolar, and Paranoid Disorders
0.309ESRDHCC 59 — Major Depressive, Bipolar, and Paranoid Disorders
0.000RxHCCHCC 133 — Personality Disorders, Anxiety, and Other Specified Mental Disorders
0.000What This Code Means
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.
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 aloneF23 — Brief psychotic disorder lasts under one month; delusional disorder requires at least one monthF06.2 — Psychotic disorder with delusions due to known physiological condition; rule out medical causesF24 — Shared psychotic disorder involves adoption of delusions from another personF22 vs. F20 — The key distinction is that delusional disorder lacks the disorganized behavior, negative symptoms, and prominent hallucinations of schizophrenia
Code Hierarchy
└F22Delusional disorders
└F22Delusional disorders