F68.13
BillableFactitious disorder imposed on self, with combined psychological and physical signs and symptoms
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F68.13 an HCC code?
No. F68.13 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 F68.13
For F68.13to 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 F68.13 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F68.13 is the ICD-10-CM diagnosis code for factitious disorder imposed on self, with combined psychological and physical signs and symptoms. A mental health condition where someone deliberately produces or exaggerates both psychological symptoms (like depression) and physical symptoms (like pain) in themselves to gain attention or sympathy. F68.13 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).
F68.13 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.
F68.13 does not map to any HCC in V28 or V24 models. RxHCC maps to 133 (0.000). No risk adjustment impact. Clinical documentation value only. Coders reviewing F68.13 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 F68.13 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document evidence of both psychological and physical symptom fabrication or exaggeration
- •Clearly indicate in the record that symptoms are intentionally produced across multiple domains
Clinical Significance
This code captures factitious disorder where both psychological and physical symptoms are deliberately falsified or produced in roughly equal measure. This combined presentation represents the most complex variant of factitious disorder, requiring coordination between psychiatric and medical specialists. These patients challenge diagnostic frameworks and drive significant costs across multiple service lines.
Documentation Requirements
- ✓Provider documentation of factitious disorder with both psychological and physical symptoms
- ✓Evidence of deliberate production of both psychiatric and somatic signs/symptoms
- ✓Documentation that neither psychological nor physical symptoms clearly predominate — both are significant
- ✓Absence of external motivating factors (differentiating from malingering)
- ✓Multidisciplinary treatment plan addressing both symptom domains
Commonly Confused Codes
- •F68.11 — Factitious disorder with predominantly psychological signs; use when psychological symptoms clearly predominate
- •F68.12 — Factitious disorder with predominantly physical signs; use when physical symptoms clearly predominate
- •F68.10 — Factitious disorder, unspecified; use F68.13 when both types are documented
- •F45.0 — Somatization disorder; somatization does not involve deliberate symptom production