F68.10
BillableFactitious disorder imposed on self, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F68.10 an HCC code?
No. F68.10 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for F68.10
For F68.10to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- 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
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed F68.10 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F68.10 is the ICD-10-CM diagnosis code for factitious disorder imposed on self, unspecified. A psychiatric condition where a person deliberately produces, exaggerates, or induces symptoms of illness in themselves to gain attention or sympathy, without a clear external reward. F68.10 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering disorders of adult personality and behavior (f60-f69).
F68.10 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
F68.10 does not map to any HCC in V28 or V24 models and has no RAF score impact. RxHCC maps to 133 (0.000). No direct risk adjustment contribution despite the high cost of care for these patients. Coders reviewing F68.10 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC — capturing the correct specificity is the highest-leverage RAF improvement available within accurate coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for F68.10 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This differs from malingering (Z76.5) which involves external incentives like avoiding work
- •Document the specific symptoms being fabricated and the pattern of deceptive behavior
Clinical Significance
Factitious disorder imposed on self (formerly Munchausen syndrome) involves deliberate falsification of medical or psychological signs and symptoms, or induction of injury or disease, in the absence of obvious external rewards. These patients drive enormous healthcare costs through unnecessary testing, procedures, and hospitalizations. Accurate identification is essential for patient safety and resource stewardship.
Documentation Requirements
- ✓Provider documentation explicitly stating factitious disorder diagnosis
- ✓Evidence of deliberate falsification, simulation, or induction of physical or psychological signs/symptoms
- ✓Documentation that deceptive behavior persists even in the absence of obvious external rewards (distinguishing from malingering)
- ✓Clinical evidence supporting the deliberate nature of symptom production (e.g., lab findings inconsistent with reported symptoms, witness observation)
- ✓Psychiatric evaluation and treatment plan
Commonly Confused Codes
- •F68.11 — Factitious disorder imposed on self, with predominantly psychological signs; use this when the factitious presentation is primarily psychiatric
- •F68.12 — Factitious disorder imposed on self, with predominantly physical signs; use this when the factitious presentation is primarily somatic
- •Z76.5 — Malingerer; malingering involves obvious external incentives (disability payments, avoiding duty) while factitious disorder does not
- •F45.x — Somatic symptom and related disorders; somatic symptom disorders involve genuine distress about symptoms without deliberate falsification