F68.12
BillableFactitious disorder imposed on self, with predominantly physical signs and symptoms
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F68.12 an HCC code?
No. F68.12 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 F68.12
For F68.12to 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 F68.12 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F68.12 is the ICD-10-CM diagnosis code for factitious disorder imposed on self, with predominantly physical signs and symptoms. A mental health condition where someone deliberately produces or exaggerates physical symptoms or illnesses in themselves (such as pain, bleeding, or infections) to gain attention or sympathy. F68.12 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).
F68.12 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.
F68.12 does not map to any HCC in V28 or V24 models. RxHCC maps to 133 (0.000). No RAF score impact despite extremely high healthcare utilization associated with this condition. Coders reviewing F68.12 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 F68.12 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document medical evidence that symptoms are self-induced or exaggerated rather than organically caused
- •Ensure thorough diagnostic workup has ruled out genuine medical conditions before coding
Clinical Significance
This subtype of factitious disorder involves deliberate falsification, simulation, or induction of physical symptoms or disease. Classic presentations include self-injection of contaminants, manipulation of laboratory specimens, feigning fever, or deliberate wound interference. These patients are at high risk for iatrogenic injury from unnecessary surgeries, procedures, and medications. Proper coding is critical for care coordination across providers.
Documentation Requirements
- ✓Provider documentation of factitious disorder with predominantly physical symptom presentation
- ✓Clinical evidence of deliberate production or falsification of physical signs (e.g., self-contamination, specimen tampering, wound manipulation)
- ✓Documentation that the behavior is not motivated by external rewards (ruling out malingering)
- ✓Medical evidence supporting deliberate nature — lab inconsistencies, witnessed behavior, or clinical findings inconsistent with known disease processes
- ✓Treatment plan addressing both the factitious behavior and any real medical complications from self-harm
Commonly Confused Codes
- •F68.10 — Factitious disorder imposed on self, unspecified; use F68.12 when physical symptoms clearly predominate
- •F68.13 — Factitious disorder with combined psychological and physical signs; when both types are equally present
- •Z76.5 — Malingerer; malingering has external incentives
- •T14.91 — Suicide attempt, unspecified; factitious self-harm is for the purpose of assuming a sick role, not self-destruction