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.
Check R11.16 with the rest of the claim: free scrubberCode 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
A category’s note binds every code beneath it.
Written on R11: Nausea and vomiting
Other codes that can never be billed with R11.16
Their own Excludes1 notes name this code, so the conflict is not listed above.
- 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
R11.16 is named in 5 Medicare coverage policies: 5 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- 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)
Alphabetic index entries that lead here
- Syndrome›cannabinoid hyperemesis
- Syndrome›cannabis hyperemesis
Code history
- addedFY2024-FY2027
Cannabis hyperemesis syndrome