Skip to content
HCC Buddy home

F53.1 ICD-10-CM Code: Puerperal psychosis

F53.1 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 · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupF53.1

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Behavioral syndromes associated with physiological disturbances and physical factors (F50-F59)

F53.1

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

Puerperal psychosis

A severe mental health condition occurring after childbirth characterized by psychotic symptoms such as hallucinations, delusions, or loss of contact with reality. This is a psychiatric emergency requiring immediate treatment.

Buddy the Bee presenting code insight

Buddy Insight

Puerperal psychosis is a psychiatric emergency occurring in approximately 1-2 per 1,000 deliveries, typically within the first two weeks postpartum.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

HCC 152

Coefficient HCC 152: 0.484 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

Context needed

HCC 087_2

Coefficient needs member context

ESRD/PACE

Context needed

HCC 58

Coefficient needs member context

RXHCC

Context needed

HCC 132

Coefficient needs member context

Code Book Path

Official
F53Mental and behavioral disorders associated with the puerperium, not elsewhere classifiedF53.1Puerperal psychosis

Inclusion Terms

Official
  • Postpartum psychosis
  • Puerperal psychosis, NOS

Excludes 2

Official
  • symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99

Related Codes

Official
F53.0Postpartum depression

Includes

Official
  • disorders of psychological developmentInherited from F01-F99

Excludes 1

Official
  • mood disorders with psychotic features (F30.2, F31.2, F31.5, F31.64, F32.3, F33.3)Inherited from F53
  • postpartum dysphoria (O90.6)Inherited from F53
  • psychosis in schizophrenia, schizotypal, delusional, and other psychotic disorders (F20-F29)Inherited from F53

Code First

Official

No Code First sequencing instructions are included in this display for F53.1. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F53.1. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F53.1. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
Documentation of psychotic symptoms (delusions, hallucinations, disorganized thinking/behavior) with onset in the postpartum period
Temporal relationship to recent delivery (typically within first 2-4 weeks postpartum)
Assessment of danger to self and infant including specific safety evaluation
Differentiation from postpartum depression with psychotic features vs. primary psychotic episode

MEAT Support

HCC Buddy guidance
Documentation of psychotic symptoms (delusions, hallucinations, disorganized thinking/behavior) with onset in the postpartum period
Temporal relationship to recent delivery (typically within first 2-4 weeks postpartum)
Assessment of danger to self and infant including specific safety evaluation
Differentiation from postpartum depression with psychotic features vs. primary psychotic episode

Audit Caution

HCC Buddy guidance
Coding postpartum depression (F53.0) when psychotic features are present — psychosis elevates to F53.1
Missing the diagnosis when presentation resembles mania or mixed states — puerperal psychosis often has bipolar features
Failing to recognize the emergency nature of this condition — this requires immediate intervention
Not capturing this specific code and defaulting to generic psychosis codes when the postpartum context is documented

Common Mistakes

HCC Buddy guidance
F53.0 (Postpartum depression) — depression WITHOUT psychotic features; F53.1 requires psychosis
F23 (Brief psychotic disorder) — use when psychosis is NOT temporally related to delivery
F25.x (Schizoaffective disorder) — chronic psychotic/mood disorder not specific to postpartum period
F31.x (Bipolar disorder) — puerperal psychosis may represent bipolar onset; code F53.1 when the postpartum context is primary

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 F53.1 an HCC code?

Yes. F53.1 (Puerperal psychosis) 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: F53.1 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
F53.1
Description
Puerperal psychosis
HCC (V28)
HCC 152 — Psychosis, Except Schizophrenia
RAF reference coefficient
0.484
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 152, Psychosis, Except Schizophrenia
0.484

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 F53.1 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F53.1

For F53.1, 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

Get the V28 mapping + MEAT cheat sheet

One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.

Free PDF. No card. Unsubscribe anytime.

What This Code Means

F53.1 is the ICD-10-CM diagnosis code for puerperal psychosis. A severe mental health condition occurring after childbirth characterized by psychotic symptoms such as hallucinations, delusions, or loss of contact with reality. This is a psychiatric emergency requiring immediate treatment. F53.1 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering behavioral syndromes associated with physiological disturbances and physical factors (f50-f59).

Under the CMS-HCC V28 risk adjustment model, F53.1 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.

This is a serious condition requiring urgent psychiatric intervention; ensure documentation clearly links psychotic symptoms to the postpartum period. For F53.1, 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 F53.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •This is a serious condition requiring urgent psychiatric intervention; ensure documentation clearly links psychotic symptoms to the postpartum period
  • •Code any associated psychotic features separately if they are documented in detail

Clinical Significance

Puerperal psychosis is a psychiatric emergency occurring in approximately 1-2 per 1,000 deliveries, typically within the first two weeks postpartum. It presents with rapid onset of psychotic symptoms including delusions, hallucinations, disorganized behavior, and severe mood disturbance. This condition carries significant risk of infanticide and maternal suicide, requiring immediate hospitalization. It maps to multiple HCC categories reflecting its severity.

Documentation Requirements

  • ✓Documentation of psychotic symptoms (delusions, hallucinations, disorganized thinking/behavior) with onset in the postpartum period
  • ✓Temporal relationship to recent delivery (typically within first 2-4 weeks postpartum)
  • ✓Assessment of danger to self and infant including specific safety evaluation
  • ✓Differentiation from postpartum depression with psychotic features vs. primary psychotic episode
  • ✓Hospitalization or intensive outpatient treatment documentation

Commonly Confused Codes

  • •F53.0 (Postpartum depression): depression WITHOUT psychotic features; F53.1 requires psychosis
  • •F23 (Brief psychotic disorder): use when psychosis is NOT temporally related to delivery
  • •F25.x (Schizoaffective disorder): chronic psychotic/mood disorder not specific to postpartum period
  • •F31.x (Bipolar disorder): puerperal psychosis may represent bipolar onset; code F53.1 when the postpartum context is primary
  • •F20.x (Schizophrenia): chronic psychotic disorder, distinct from acute puerperal psychosis

Child Codes

F53.0Postpartum depression
F53.1Puerperal psychosis
HCC 152

Code Hierarchy

└F53Mental and behavioral disorders associated with the puerperium, not elsewhere classified└F53.1Puerperal psychosis
└F53.1Puerperal psychosis

F53.1 code history

Code setChange
FY2019 (effective Oct 1, 2018)Added to the code set

Source: official CMS ICD-10-CM order and addenda files, FY2016 through FY2027.

Also searched as

  • F53 1
  • F531

For F53.1, 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.

F53.1 maps to CMS-HCC V28 category 152, Psychosis, Except Schizophrenia. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for F53.1. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

Work F53.1 in HCC Buddy

Open F53.1 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

Open in Code BookOpen in EncoderStart Pro