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F19.259 ICD-10-CM Code: Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder, unspecified

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 F19.259 in the official ICD-10-CM tabular list, quoted as published.

Notes without a marker are published on F19.259 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 F19.2

Coder workflow for F19.259

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

Before you code F19.259

  1. Unspecified does not mean incorrect. When the record gives no greater specificity, F19.259 may be the appropriate code. Check the record for detail that supports a more specific sibling — in this subcategory the siblings differ by the presence or absence of the associated condition. An unspecified code is for records that do not provide the detail a more specific code needs; a query, not an assumption, is the route to specificity (Guidelines I.A.9.b, I.B.18).

    ReviewF19.250, F19.251

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

  2. F19.259’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 F19.259. 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 record document the detail a more specific sibling code needs?
    Yes → Review the specific siblings in this subcategory.
    No → Continue — F19.259 is appropriate when the documentation goes no further.

    ReviewF19.250, F19.251

  2. Does the documentation support a condition named in F19.259’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.

    ReviewF19.1, F19.9

Consider F19.259. 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 F19.259(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with F19.259: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareF19.1, 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: The provider documents the condition in the terms of this code’s title and records no further detail.

Coding question: Is a more specific sibling code supportable?

Path: Review the specific siblings in this subcategory and what each requires the record to state.

Reason: A more specific code needs documentation of the distinguishing element; without it the unspecified code is appropriate, and a provider query is the route to specificity (Guidelines I.A.9.b, I.B.18).

ReviewF19.250, F19.251

Documentation: Both the condition F19.259 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).

ReviewF19.1, F19.9

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

Coding question: Is F19.259 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 dependence with psychoactive substance-induced psychotic disorder, unspecified is a billable ICD-10-CM diagnosis code (F19.259).

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 (1)

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

  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

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 F19.259 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: F19.1 — Other psychoactive substance abuse (via F19.2.-), F19.9 — Other psychoactive substance use, unspecified (via F19.2.-), 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 33 Excludes2 notes across 4 chapters: F02 — Dementia in other diseases classified elsewhere (via F19.-), 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.-), T41 — Poisoning by, adverse effect of and underdosing of anesthetics and therapeutic gases (via F19.-), +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 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.

CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 11 clinically related codes on its CMS exclusion list.

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); MBD001 — Schizophrenia spectrum and other psychotic disorders.

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 clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

F10.90 — Alcohol use, unspecified, uncomplicated, F10.91 — Alcohol use, unspecified, in remission, F11.91 — Opioid use, unspecified, in remission, F12.91 — Cannabis use, unspecified, in remission, F13.91 — Sedative, hypnotic or anxiolytic use, unspecified, in remission, F14.91 — Cocaine use, unspecified, in remission, F15.91 — Other stimulant use, unspecified, in remission, F16.91 — Hallucinogen use, unspecified, in remission, F18.91 — Inhalant use, unspecified, in remission, F19.91 — Other psychoactive substance use, unspecified, in remission

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.

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, F19.16 — Other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder, 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, F19.26 — 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, F19.950 — Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with delusions, F19.951 — Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with hallucinations, F19.959 — Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified, F19.96 — Other psychoactive substance use, unspecified with psychoactive substance-induced persisting amnestic disorder, F19.97 — Other psychoactive substance use, unspecified with psychoactive substance-induced persisting dementia, +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 categories (Other specified substance-related disorders, Schizophrenia spectrum and other psychotic disorders).

F19.221 — Other psychoactive substance dependence with intoxication delirium, F19.222 — Other psychoactive substance dependence with intoxication with perceptual disturbance, F19.229 — Other psychoactive substance dependence with intoxication, unspecified, F19.230 — Other psychoactive substance dependence with withdrawal, uncomplicated, F19.231 — Other psychoactive substance dependence with withdrawal delirium, F19.232 — Other psychoactive substance dependence with withdrawal with perceptual disturbance, F19.239 — Other psychoactive substance dependence with withdrawal, unspecified, F19.24 — Other psychoactive substance dependence with psychoactive substance-induced mood disorder, 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, F19.26 — Other psychoactive substance dependence with psychoactive substance-induced persisting amnestic disorder, F19.27 — Other psychoactive substance dependence with psychoactive substance-induced persisting dementia, F19.280 — Other psychoactive substance dependence with psychoactive substance-induced anxiety disorder, F19.281 — Other psychoactive substance dependence with psychoactive substance-induced sexual dysfunction, F19.282 — Other psychoactive substance dependence with psychoactive substance-induced sleep disorder, F19.288 — Other psychoactive substance dependence with other psychoactive substance-induced disorder, F19.29 — Other psychoactive substance dependence with unspecified psychoactive substance-induced disorder, F19.90 — Other psychoactive substance use, unspecified, uncomplicated, F19.920 — Other psychoactive substance use, unspecified with intoxication, uncomplicated, F19.921 — Other psychoactive substance use, unspecified with intoxication with delirium, +147 more

Same Index main term, other category

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

F18.221 — Inhalant dependence with intoxication delirium (drug NEC, inhalant, with, intoxication, with delirium), F18.229 — Inhalant dependence with intoxication, unspecified (drug NEC, inhalant, with, intoxication), F18.24 — Inhalant dependence with inhalant-induced mood disorder (drug NEC, inhalant, with, mood disorder), F18.250 — Inhalant dependence with inhalant-induced psychotic disorder with delusions (drug NEC, inhalant, with, psychosis, delusions), F18.251 — Inhalant dependence with inhalant-induced psychotic disorder with hallucinations (drug NEC, inhalant, with, psychosis, hallucinations), F18.259 — Inhalant dependence with inhalant-induced psychotic disorder, unspecified (drug NEC, inhalant, with, psychosis), F18.27 — Inhalant dependence with inhalant-induced dementia (drug NEC, inhalant, with, dementia, persisting), F18.280 — Inhalant dependence with inhalant-induced anxiety disorder (drug NEC, inhalant, with, anxiety disorder), F18.288 — Inhalant dependence with other inhalant-induced disorder (drug NEC, inhalant, with, other specified disorder), F18.29 — Inhalant dependence with unspecified inhalant-induced disorder (drug NEC, inhalant, with, unspecified disorder), F55.8 — Abuse of other non-psychoactive substances (analgesic NEC), P96.1 — Neonatal withdrawal symptoms from maternal use of drugs of addiction (drug NEC, cocaine, withdrawal symptoms in newborn), 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), Z71.6 — Tobacco abuse counseling (tobacco, counseling and surveillance), Z74.09 — Other reduced mobility (on, care provider, impaired mobility), Z74.1 — Need for assistance with personal care (on, care provider, need for, assistance with personal care), Z74.2 — Need for assistance at home and no other household member able to render care (on, care provider, no other household member able to render care), Z74.3 — Need for continuous supervision (on, care provider, need for, continuous supervision), Z74.8 — Other problems related to care provider dependency (on, care provider, specified reason NEC), +144 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 F19.259 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 F19.259 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 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

  • Dependence (on) (syndrome), drug NEC, psychoactive NEC, with, psychosis[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 dependence with psychoactive substance-induced psychotic disorder, unspecified

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 F19.259 in its code family, with their registry titles.

View all codes in the F19 family