F28

Billable

Other psychotic disorder not due to a substance or known physiological condition

HCC Category Mapping

V28HCC 152 — Delusional and Other Specified Psychotic Disorders

0.546

V24HCC 58 — Reactive and Unspecified Psychosis

0.508

ESRDHCC 58 — Reactive and Unspecified Psychosis

0.000

RxHCCHCC 130 — Schizophrenia

0.000

What This Code Means

A psychotic disorder where a person experiences hallucinations, delusions, or disorganized thinking that is not caused by substance use, medication, or a medical condition.

Coding Tips

•Ensure documentation rules out substance use, medication effects, and medical causes before coding
•This is a diagnosis of exclusion; document the workup performed to eliminate other causes

Clinical Significance

Other psychotic disorder not due to a substance or known physiological condition is a diagnosis of exclusion for psychotic presentations that do not fit standard categories (schizophrenia, delusional disorder, brief psychotic disorder, schizoaffective disorder). This may include chronic hallucinatory psychosis or other atypical psychotic presentations. It requires thorough clinical evaluation to exclude substance-induced and medical causes of psychosis. Accurate coding ensures these complex patients receive appropriate risk adjustment.

Documentation Requirements

✓Documentation of psychotic symptoms (hallucinations, delusions, disorganized thinking)
✓Assessment by a qualified mental health professional
✓Documentation ruling out substance-induced psychosis (drug screening, history)
✓Documentation ruling out psychosis due to medical conditions (metabolic, neurological, infectious workup)
✓Explanation of why the presentation does not fit schizophrenia, delusional disorder, brief psychotic disorder, or schizoaffective disorder
✓Current treatment plan and functional assessment

Commonly Confused Codes

F29 — Unspecified psychosis is for when the type cannot be determined; F28 indicates a specific type was identified but does not fit standard categories F20.89 — Other schizophrenia requires meeting full schizophrenia criteria; F28 does not F22 — Delusional disorder involves only delusions; F28 may involve other psychotic features F06.0/F06.2 — Psychotic disorders due to medical conditions should be used when an underlying medical cause is identified F1X.950/F1X.951 — Substance-induced psychotic disorders should be used when substance etiology is established

Code Hierarchy

└F28Other psychotic disorder not due to a substance or known physiological condition

F28