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F19.16 ICD-10-CM Code: Other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder

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

Coding at a Glance

Tabular directives
1 inclusion term · 2 Excludes1
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 54

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 v43, 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 135 — Drug Use with Psychotic Complications (supersedes HCC 136, HCC 137, HCC 138, HCC 139)

Other models: CMS-HCC V22 HCC 54

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 F19.16 in the official ICD-10-CM tabular list, quoted as published.

Notes without a marker are published on F19.16 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.

  • polysubstance drug use (indiscriminate drug use)

Source: inherited from F19

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 F19.1

Coder workflow for F19.16

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

Before you code F19.16

  1. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on F19.16; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. F19.16’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

    Guide: Combination codes →

  3. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with F19.16. 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 F19.16’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.

    ReviewF19.2, F19.9

Consider F19.16. 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).
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).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes1 — check before selecting F19.16(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with F19.16: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareF19.2, F19.9

    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 F19.16 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).

ReviewF19.2, F19.9

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is F19.16 supported?

Path: Review the code for the documented component on its own.

Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.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.

Code Overview

Other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder is a billable ICD-10-CM diagnosis code (F19.16).

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

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.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official 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 5: Mental, Behavioral and Neurodevelopmental disorders (F01 – F99)

1) In Remission Selection of codes describing “in remission” for categories F10-F19, Mental and behavioral disorders due to psychoactive substance use (categories F10-F19 with -.11, -.21, -.91) requires the provider’s clinical judgment and are assigned only on the basis of provider documentation (as defined in the Official Guidelines for Coding and Reporting), unless otherwise instructed by the classification.

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 structured relationships — computed from published CMS and AHRQ datasets

Other codes that name F19.16 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: F19.2 — Other psychoactive substance dependence (via F19.1.-), F19.9 — Other psychoactive substance use, unspecified (via F19.1.-), R41.3 — Other amnesia (via F19.-), R44 — Other symptoms and signs involving general sensations and perceptions (via F19.-).

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

Referenced by 34 Excludes2 notes across 4 chapters: F02 — Dementia in other diseases classified elsewhere (via F19.-), F04 — Amnestic disorder due to known physiological condition, F06 — Other mental disorders due to known physiological condition (via F19.-), F06.0 — Psychotic disorder with hallucinations due to known physiological condition (via F19.-), F06.2 — Psychotic disorder with delusions due to known physiological condition (via F19.-), F06.3 — Mood disorder due to known physiological condition (via F19.-), F06.4 — Anxiety disorder due to known physiological condition (via F19.-), F20 — Schizophrenia (via F19.-), F55 — Abuse of non-psychoactive substances (via F19.-), F63 — Impulse disorders (via F19.-), F63.1 — Pyromania (via F19.-), R78 — Findings of drugs and other substances, not normally found in blood (via F19.-), T36 — Poisoning by, adverse effect of and underdosing of systemic antibiotics (via F19.-), T36-T39 — Antibiotics & Anti-infectives (T36-T39) (via F19.-), T36-T50 — Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances (T36-T50) (via F19.-), T37 — Poisoning by, adverse effect of and underdosing of other systemic anti-infectives and antiparasitics (via F19.-), T38 — Poisoning by, adverse effect of and underdosing of hormones and their synthetic substitutes and antagonists, not elsewhere classified (via F19.-), T39 — Poisoning by, adverse effect of and underdosing of nonopioid analgesics, antipyretics and antirheumatics (via F19.-), T40 — Poisoning by, adverse effect of and underdosing of narcotics and psychodysleptics [hallucinogens] (via F19.-), T40-T41 — Analgesics & Antipyretics (T40-T41) (via F19.-), +14 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 F19.-), Z71.5 — Drug abuse counseling and surveillance (via F19.-).

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

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

Not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity.

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):MBD025 — Other specified substance-related disorders (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 with Psychotic Complications) for risk-adjusted payment.

F18.27 — Inhalant dependence with inhalant-induced dementia, F18.950 — Inhalant use, unspecified with inhalant-induced psychotic disorder with delusions, F18.951 — Inhalant use, unspecified with inhalant-induced psychotic disorder with hallucinations, F18.959 — Inhalant use, unspecified with inhalant-induced psychotic disorder, unspecified, F18.97 — Inhalant use, unspecified with inhalant-induced persisting dementia, F19.131 — Other psychoactive substance abuse with withdrawal delirium, F19.132 — Other psychoactive substance abuse with withdrawal with perceptual disturbance, F19.150 — Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with delusions, F19.151 — Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with hallucinations, F19.159 — Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder, unspecified, F19.17 — Other psychoactive substance abuse with psychoactive substance-induced persisting dementia, F19.231 — Other psychoactive substance dependence with withdrawal delirium, F19.232 — Other psychoactive substance dependence with withdrawal with perceptual disturbance, F19.250 — Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with delusions, F19.251 — Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with hallucinations, F19.259 — Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder, unspecified, F19.26 — Other psychoactive substance dependence with psychoactive substance-induced persisting amnestic disorder, F19.27 — Other psychoactive substance dependence with psychoactive substance-induced persisting dementia, F19.931 — Other psychoactive substance use, unspecified with withdrawal delirium, F19.932 — Other psychoactive substance use, unspecified with withdrawal with perceptual disturbance, +76 more

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.

Alcohol Use with Psychotic Complications, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications, Drug Use Disorder, Mild, Uncomplicated, Except Cannabis, 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 (Other specified substance-related disorders).

F19.122 — Other psychoactive substance abuse with intoxication with perceptual disturbances, F19.129 — Other psychoactive substance abuse with intoxication, unspecified, F19.130 — Other psychoactive substance abuse with withdrawal, uncomplicated, F19.131 — Other psychoactive substance abuse with withdrawal delirium, F19.132 — Other psychoactive substance abuse with withdrawal with perceptual disturbance, F19.139 — Other psychoactive substance abuse with withdrawal, unspecified, F19.14 — Other psychoactive substance abuse with psychoactive substance-induced mood disorder, F19.150 — Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with delusions, F19.151 — Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with hallucinations, F19.159 — Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder, unspecified, F19.17 — Other psychoactive substance abuse with psychoactive substance-induced persisting dementia, F19.180 — Other psychoactive substance abuse with psychoactive substance-induced anxiety disorder, F19.181 — Other psychoactive substance abuse with psychoactive substance-induced sexual dysfunction, F19.182 — Other psychoactive substance abuse with psychoactive substance-induced sleep disorder, F19.188 — Other psychoactive substance abuse with other psychoactive substance-induced disorder, F19.19 — Other psychoactive substance abuse with unspecified psychoactive substance-induced disorder, F19.20 — Other psychoactive substance dependence, uncomplicated, F19.220 — Other psychoactive substance dependence with intoxication, uncomplicated, F19.221 — Other psychoactive substance dependence with intoxication delirium, F19.222 — Other psychoactive substance dependence with intoxication with perceptual disturbance, +52 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.

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), F18.180 — Inhalant abuse with inhalant-induced anxiety disorder (drug NEC, inhalant, with, anxiety disorder), F18.188 — Inhalant abuse with other inhalant-induced disorder (drug NEC, inhalant, with, other specified disorder), F18.19 — Inhalant abuse with unspecified inhalant-induced disorder (drug NEC, inhalant, with, unspecified disorder), F55.0 — Abuse of antacids (antacids), F55.1 — Abuse of herbal or folk remedies (herbal or folk remedies), F55.2 — Abuse of laxatives (laxatives), F55.3 — Abuse of steroids or hormones (hormones), F55.4 — Abuse of vitamins (vitamins), F55.8 — Abuse of other non-psychoactive substances (analgesics), Z63.0 — Problems in relationship with spouse or partner (adult, as reason for, couple seeking advice), Z71.41 — Alcohol abuse counseling and surveillance of alcoholic (alcohol, counseling and surveillance), Z71.51 — Drug abuse counseling and surveillance of drug abuser (drug NEC, counseling and surveillance), +117 more

Contextual Map

Every relationship of F19.16 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 F19.16 with these 14 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes (34)

Referenced by Use Additional Code instructions

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 135 — Drug Use with Psychotic Complications [CMS-HCC]: “Drug Use with Psychotic Complications — supersedes HCC 136 (Alcohol Use with Psychotic Complications), HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications), HCC 138 (Drug Use Disorder, Mild, Uncomplicated, Except Cannabis), 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 · FY2026

Index entries

  • Abuse, drug NEC (non-dependent), psychoactive NEC, with, amnestic disorder[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Amnes (t)ic syndrome (post-traumatic), induced by, psychoactive NEC, with, abuse[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Disorder (of), amnesic, amnestic, psychoactive NEC-induced, with, abuse[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (40)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

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 FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 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 — v43 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 structured 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 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.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to F19.16 in its code family, with their registry titles.

View all codes in the F19 family