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F16.11 ICD-10-CM Code: Hallucinogen abuse, in remission

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Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
7 inclusion terms · 2 Excludes1
Risk adjustment
CMS-HCC V28: 1 category

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too; the Instructions section marks which is which.

Excludes1Never report with this code
  • hallucinogen dependence (F16.2-)
  • hallucinogen use, unspecified (F16.9-)
IncludesWhat this code covers
  • ecstasy
  • PCP
  • phencyclidine
  • Other hallucinogen use disorder, mild, in early remission

+3 more in Instructions

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 894 — ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA (MDC 20)
  • MS-DRG 895 — ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY (MDC 20)
  • MS-DRG 896 — ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC (MDC 20)
  • MS-DRG 897 — ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC (MDC 20)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 138 — Drug Use Disorder, Mild, Uncomplicated, Except Cannabis (supersedes HCC 139)

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for F16.11 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on F16.11 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • ecstasy
  • PCP
  • phencyclidine

Source: inherited from F16

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Other hallucinogen use disorder, mild, in early remission
  • Other hallucinogen use disorder, mild, in sustained remission
  • Phencyclidine use disorder, mild, in early remission
  • Phencyclidine use disorder, mild, in sustained remission

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from F16.1

Coder workflow for F16.11

MedCoder structured workflow — derived from this code’s own official record

Before you code F16.11

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with F16.11. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in F16.11’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewF16.2, F16.9

Consider F16.11. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Remission status
Remission is coded only when the provider documents it.
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).

Official instructions as workflow

  • Excludes1 — check before selecting F16.11(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with F16.11: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareF16.2, F16.9

    See the official tabular notes · Guidelines I.A.12.a

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition F16.11 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewF16.2, F16.9

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse F16.11 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of F16.11 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • F16.2— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of hallucinogen dependence moves the case to F16.2; the two are not reported together unless documented as unrelated.

    Full comparison: F16.11 vs F16.2 →

  • F16.9— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of hallucinogen use, unspecified moves the case to F16.9; the two are not reported together unless documented as unrelated.

    Full comparison: F16.11 vs F16.9 →

  • F16.19— Specificity relationship (Review)

    Overlapping diagnoses in the same category.

    Overlapping codes in the same category — the documentation decides which is the more specific fit.

    What moves you there: A record that documents no more than “Hallucinogen abuse with unspecified hallucinogen-induced disorder” takes F16.19; specificity in the record moves it back here.

    Full comparison: F16.11 vs F16.19 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Hallucinogen abuse, in remission is a billable ICD-10-CM diagnosis code (F16.11).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A)

3) Drug use during pregnancy, childbirth and the puerperium Codes under subcategory O99.32, Drug use complicating pregnancy, childbirth, and the puerperium, should be assigned for any pregnancy case when a patient uses drugs during the pregnancy or postpartum. This can involve illegal drugs, or inappropriate use or abuse of prescription drugs. Secondary code(s) from categories F11-F16 and F18-F19 should also be assigned to identify manifestations of the drug use.

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name F16.11 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 4 Excludes1 notes across 2 chapters: F16.2 — Hallucinogen dependence (via F16.1.-), F16.9 — Hallucinogen use, unspecified (via F16.1.-), R41.3 — Other amnesia (via F16.-), R44 — Other symptoms and signs involving general sensations and perceptions (via F16.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 33 Excludes2 notes across 4 chapters: F02 — Dementia in other diseases classified elsewhere (via F16.-), F06 — Other mental disorders due to known physiological condition (via F16.-), F06.0 — Psychotic disorder with hallucinations due to known physiological condition (via F16.-), F06.2 — Psychotic disorder with delusions due to known physiological condition (via F16.-), F06.3 — Mood disorder due to known physiological condition (via F16.-), F06.4 — Anxiety disorder due to known physiological condition (via F16.-), F20 — Schizophrenia (via F16.-), F55 — Abuse of non-psychoactive substances (via F16.-), F63 — Impulse disorders (via F16.-), F63.1 — Pyromania (via F16.-), R78 — Findings of drugs and other substances, not normally found in blood (via F16.-), T36 — Poisoning by, adverse effect of and underdosing of systemic antibiotics (via F16.-), T36-T39 — Antibiotics & Anti-infectives (T36-T39) (via F16.-), T36-T50 — Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances (T36-T50) (via F16.-), T37 — Poisoning by, adverse effect of and underdosing of other systemic anti-infectives and antiparasitics (via F16.-), T38 — Poisoning by, adverse effect of and underdosing of hormones and their synthetic substitutes and antagonists, not elsewhere classified (via F16.-), T39 — Poisoning by, adverse effect of and underdosing of nonopioid analgesics, antipyretics and antirheumatics (via F16.-), T40 — Poisoning by, adverse effect of and underdosing of narcotics and psychodysleptics [hallucinogens] (via F16.-), T40-T41 — Analgesics & Antipyretics (T40-T41) (via F16.-), T41 — Poisoning by, adverse effect of and underdosing of anesthetics and therapeutic gases (via F16.-), +13 more.

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 2 Use Additional Code instructions across 2 chapters: O99.32 — Drug use complicating pregnancy, childbirth, and the puerperium (via F16.-), Z71.5 — Drug abuse counseling and surveillance (via F16.-).

These codes instruct coders to additionally report this code when it applies.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 4 MS-DRGs: DRG 894 (MDC 20), DRG 895 (MDC 20), DRG 896 (MDC 20), DRG 897 (MDC 20).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):MBD026 — Mental and substance use disorders in remission (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Drug Use Disorder, Mild, Uncomplicated, Except Cannabis) for risk-adjusted payment.

F11.10 — Opioid abuse, uncomplicated, F11.11 — Opioid abuse, in remission, F13.10 — Sedative, hypnotic or anxiolytic abuse, uncomplicated, F13.11 — Sedative, hypnotic or anxiolytic abuse, in remission, F14.10 — Cocaine abuse, uncomplicated, F14.11 — Cocaine abuse, in remission, F15.10 — Other stimulant abuse, uncomplicated, F15.11 — Other stimulant abuse, in remission, F16.10 — Hallucinogen abuse, uncomplicated, F18.10 — Inhalant abuse, uncomplicated, F18.11 — Inhalant abuse, in remission, F19.10 — Other psychoactive substance abuse, uncomplicated, F19.11 — Other psychoactive substance abuse, in remission

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Drug Use with Psychotic Complications, Alcohol Use with Psychotic Complications, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications, Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Mental and substance use disorders in remission).

F12.91 — Cannabis use, unspecified, in remission, F13.11 — Sedative, hypnotic or anxiolytic abuse, in remission, F13.21 — Sedative, hypnotic or anxiolytic dependence, in remission, F13.91 — Sedative, hypnotic or anxiolytic use, unspecified, in remission, F14.11 — Cocaine abuse, in remission, F14.21 — Cocaine dependence, in remission, F14.91 — Cocaine use, unspecified, in remission, F15.11 — Other stimulant abuse, in remission, F15.21 — Other stimulant dependence, in remission, F15.91 — Other stimulant use, unspecified, in remission, F16.21 — Hallucinogen dependence, in remission, F16.91 — Hallucinogen use, unspecified, in remission, F17.201 — Nicotine dependence, unspecified, in remission, F17.211 — Nicotine dependence, cigarettes, in remission, F17.221 — Nicotine dependence, chewing tobacco, in remission, F17.291 — Nicotine dependence, other tobacco product, in remission, F18.11 — Inhalant abuse, in remission, F18.21 — Inhalant dependence, in remission, F18.91 — Inhalant use, unspecified, in remission, F19.11 — Other psychoactive substance abuse, in remission, +23 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Abuse”; these codes share that main term but sit in a different category of the Tabular List.

F15.13 — Other stimulant abuse with withdrawal (drug NEC, stimulant NEC, with, withdrawal), F15.14 — Other stimulant abuse with stimulant-induced mood disorder (drug NEC, stimulant NEC, with, mood disorder), F15.150 — Other stimulant abuse with stimulant-induced psychotic disorder with delusions (drug NEC, stimulant NEC, with, psychosis, delusions), F15.151 — Other stimulant abuse with stimulant-induced psychotic disorder with hallucinations (drug NEC, stimulant NEC, with, psychosis, hallucinations), F15.159 — Other stimulant abuse with stimulant-induced psychotic disorder, unspecified (drug NEC, stimulant NEC, with, psychosis), F15.180 — Other stimulant abuse with stimulant-induced anxiety disorder (drug NEC, stimulant NEC, with, anxiety disorder), F15.181 — Other stimulant abuse with stimulant-induced sexual dysfunction (drug NEC, stimulant NEC, with, sexual dysfunction), F15.182 — Other stimulant abuse with stimulant-induced sleep disorder (drug NEC, stimulant NEC, with, sleep disorder), F15.188 — Other stimulant abuse with other stimulant-induced disorder (drug NEC, stimulant NEC, with, other specified disorder), F15.19 — Other stimulant abuse with unspecified stimulant-induced disorder (drug NEC, stimulant NEC, with, unspecified disorder), F18.10 — Inhalant abuse, uncomplicated (drug NEC, inhalant), F18.11 — Inhalant abuse, in remission (drug NEC, inhalant, in remission), F18.120 — Inhalant abuse with intoxication, uncomplicated (drug NEC, inhalant, with, intoxication, uncomplicated), F18.121 — Inhalant abuse with intoxication delirium (drug NEC, inhalant, with, intoxication, with delirium), F18.129 — Inhalant abuse with intoxication, unspecified (drug NEC, inhalant, with, intoxication), F18.14 — Inhalant abuse with inhalant-induced mood disorder (drug NEC, inhalant, with, mood disorder), F18.150 — Inhalant abuse with inhalant-induced psychotic disorder with delusions (drug NEC, inhalant, with, psychosis, delusions), F18.151 — Inhalant abuse with inhalant-induced psychotic disorder with hallucinations (drug NEC, inhalant, with, psychosis, hallucinations), F18.159 — Inhalant abuse with inhalant-induced psychotic disorder, unspecified (drug NEC, inhalant, with, psychosis), F18.17 — Inhalant abuse with inhalant-induced dementia (drug NEC, inhalant, with, dementia, persisting), +119 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Gamma-glutamyl Transferase (GGT) Test

Contextual Map

Every relationship of F16.11 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run F16.11 with these 14 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes (33)

Referenced by Use Additional Code instructions

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 138 — Drug Use Disorder, Mild, Uncomplicated, Except Cannabis [CMS-HCC]: “Drug Use Disorder, Mild, Uncomplicated, Except Cannabis — supersedes HCC 139 (Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications)”— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

  • MDC 20 — Alcohol or Drug Use or Induced Organic Mental Disorders[MDC crossing]: “Alcohol or Drug Use or Induced Organic Mental Disorders — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 35 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Index entries

  • Abuse, drug NEC (non-dependent), hallucinogen, in remission (early) (sustained)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Disorder (of), hallucinogen use, mild, in remission (early) (sustained)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Disorder (of), phencyclidine use, mild, in remission (early) (sustained)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes (40)

Change history

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Indexed Clinical Terms (3)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2027), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder-derived relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder editorial explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 20, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "F16.11 — Hallucinogen abuse, in remission." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/f16.11-hallucinogen-abuse-in-remission

Change history

  • FY2018 — October 1, 2017
    Added to the code set
    Hallucinogen abuse, in remission
    FY2018 changes

Nearest Codes in This Family

Official ICD-10-CM classifications closest to F16.11 in its code family, with their registry titles.

View all codes in the F16 family