F16.959 — Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder, unspecified
F16.959 is a billable, specific ICD-10-CM code for hallucinogen use, unspecified with hallucinogen-induced psychotic disorder, unspecified. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Other hallucinogen induced psychotic disorder, without use disorder
- Phencyclidine induced psychotic disorder, without use disorder
Risk adjustment
F16.959 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 135 Drug 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.
Medicare coverage
F16.959 is named in 15 Medicare coverage policies — 12 listing it as supporting medical necessity, and 3 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
- A56562Billing and Coding: Health and Behavior Assessment/Interventionnot covered
- A59718Billing and Coding: Opioid Treatment Programsnot covered
- A56614Billing and Coding: Psychiatric Inpatient Hospitalization
How F16.959 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to F16.959.
- Phencyclidine-induced›psychotic disorder
- Use›hallucinogen NEC›with›psychosis
Related codes at this level
Codes that share F16.95. If F16.959 is not quite right, the correct code is usually one of these.
Questions about F16.959
- Is F16.959 a billable ICD-10-CM code?
- Yes. F16.959 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does F16.959 sit in the tabular list?
- Mental, Behavioral and Neurodevelopmental disorders (F01-F99), in the block Mental and behavioral disorders due to psychoactive substance use (F10-F19).