F10-F19 — Mental and behavioral disorders due to psychoactive substance use

Risk adjustment in F10-F19

0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.

• HCC 137 Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
• HCC 135 Drug Use with Psychotic Complications
• HCC 139 Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications
• HCC 136 Alcohol Use with Psychotic Complications
• HCC 138 Drug Use Disorder, Mild, Uncomplicated, Except Cannabis

What else to watch in F10-F19

• 458 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.