F68.11
BillableFactitious disorder imposed on self, with predominantly psychological signs and symptoms
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F68.11 an HCC code?
No. F68.11 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 F68.11
For F68.11to 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 F68.11 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F68.11 is the ICD-10-CM diagnosis code for factitious disorder imposed on self, with predominantly psychological signs and symptoms. A mental health condition where someone deliberately produces or exaggerates psychological symptoms (like anxiety, depression, or memory problems) in themselves to gain attention or sympathy. F68.11 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).
F68.11 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.
F68.11 does not map to any HCC in V28 or V24 models. RxHCC maps to 133 (0.000). No direct RAF score contribution. Code for clinical accuracy and to flag high-utilization patterns. Coders reviewing F68.11 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 F68.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document evidence of intentional symptom production or exaggeration in the medical record
- •Distinguish from genuine mental health conditions by noting the factitious nature and secondary gain motivation
Clinical Significance
This subtype of factitious disorder involves deliberate falsification or exaggeration of psychological symptoms such as feigning psychosis, depression, PTSD, or cognitive deficits. It is particularly challenging to diagnose because psychiatric symptoms are inherently subjective. These patients may undergo unnecessary psychiatric hospitalizations and medications with real side effects. Accurate identification prevents iatrogenic harm.
Documentation Requirements
- ✓Provider documentation of factitious disorder with predominantly psychological symptom presentation
- ✓Evidence of deliberate falsification or exaggeration of psychiatric symptoms (e.g., inconsistencies in reported symptoms, atypical presentation patterns)
- ✓Documentation that symptom production is not motivated by external rewards
- ✓Clinical evidence distinguishing factitious psychiatric symptoms from genuine psychiatric illness
- ✓Psychiatric evaluation including the rationale for the factitious disorder diagnosis
Commonly Confused Codes
- •F68.10 — Factitious disorder imposed on self, unspecified; use F68.11 when the presentation is predominantly psychological
- •F68.12 — Factitious disorder imposed on self, with predominantly physical signs; when physical symptoms predominate
- •Z76.5 — Malingerer; external incentive is the distinguishing factor
- •F44.x — Dissociative/conversion disorders; conversion symptoms are not deliberately produced, unlike factitious symptoms