F19.97: Other psychoactive substance use, unspecified with psychoactive substance-induced persisting dementia

Risk adjustment

F19.97 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

F19.97 is named in 13 Medicare coverage policies: 12 listing it as supporting medical necessity, and 1 listing it as NOT covered. Which one applies depends on your Medicare contractor.

• A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
• A56645Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
• A56756Billing and Coding: Home Health - Psychiatric Care
• A56767Billing and Coding: Heavy Metal Testing