F10.96: Alcohol use, unspecified with alcohol-induced persisting amnestic disorder

Risk adjustment

F10.96 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 136 Alcohol Use with Psychotic Complications0.424 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

F10.96 is named in 11 Medicare coverage policies: 9 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which one applies depends on your Medicare contractor.

• A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
• A59718Billing and Coding: Opioid Treatment Programsnot covered
• A56612Billing and Coding: CT of the Head
• A56645Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing