F19.959: Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified

Risk adjustment

F19.959 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

F19.959 is named in 14 Medicare coverage policies: 12 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
• A56562Billing and Coding: Health and Behavior Assessment/Interventionnot covered
• A56614Billing and Coding: Psychiatric Inpatient Hospitalization
• A56645Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing