R11.16 — Cannabis hyperemesis syndrome
R11.16 is a billable, specific ICD-10-CM code for cannabis hyperemesis syndrome. It is valid for submission on a claim.
Code also
Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Cannabinoid hyperemesis syndrome
Excludes1 inherited from the categories above R11.16
These are not written on R11.16, but they bind it: a note on a category applies to every code beneath it. Billing R11.16 with anything listed here is a denial.
Written on R11 — Nausea and vomiting
Other codes that can never be billed with R11.16
These codes carry an Excludes1 note pointing at R11.16. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading R11.16 alone.
- P92.0Vomiting of newborn
Risk adjustment
R11.16 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 137 Drug Use Disorder, Moderate/Severe, or Drug Use with Non-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
R11.16 is named in 5 Medicare coverage policies — 5 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A56389Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization
- A56421Billing and Coding: CT of the Abdomen and Pelvis
- A56632Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
- A57414Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
How R11.16 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 R11.16.
- Syndrome›cannabinoid hyperemesis
- Syndrome›cannabis hyperemesis
Code history
What changed, and when. Derived by diffing consecutive CMS release files — which matters when you are defending a code assigned under an earlier edition.
- addedFY2024-FY2026
Cannabis hyperemesis syndrome
Related codes at this level
Codes that share R11.1. If R11.16 is not quite right, the correct code is usually one of these.
Questions about R11.16
- Is R11.16 a billable ICD-10-CM code?
- Yes. R11.16 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does R11.16 sit in the tabular list?
- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99), in the block Symptoms and signs involving the digestive system and abdomen (R10-R19).
- What cannot be coded together with R11.16?
- R11.16 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above R11.16 (R11) and apply to it just the same.