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F28 ICD-10-CM Code: Other psychotic disorder not due to a substance or known physiological condition

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

Coding at a Glance

Tabular directives
2 inclusion terms
Risk adjustment
CMS-HCC V28: 1 category · RxHCC V08 category 130

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 885 — PSYCHOSES (MDC 19)
  • MS-DRG 974 — HIV WITH MAJOR RELATED CONDITION WITH MCC (MDC 25)
  • MS-DRG 975 — HIV WITH MAJOR RELATED CONDITION WITH CC (MDC 25)
  • MS-DRG 976 — HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC (MDC 25)

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 152 — Psychosis, Except Schizophrenia (supersedes HCC 153, HCC 154, HCC 155)

Other models: RxHCC V08 HCC 130

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 F28 in the official ICD-10-CM tabular list, quoted as published.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Chronic hallucinatory psychosis
  • Other specified schizophrenia spectrum and other psychotic disorder

Coder workflow for F28

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

Before you code F28

  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 F28; 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. F28’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 →

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.

Coding decision scenarios

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

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

Coding question: Is F28 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 psychotic disorder not due to a substance or known physiological condition is a billable ICD-10-CM diagnosis code (F28).

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 (8)

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.

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 F28 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 3 Excludes1 notes across 2 chapters: F53 — Mental and behavioral disorders associated with the puerperium, not elsewhere classified, R44 — Other symptoms and signs involving general sensations and perceptions, R46 — Symptoms and signs involving appearance and behavior.

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

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 885 (MDC 19), DRG 974 (MDC 25), DRG 975 (MDC 25), DRG 976 (MDC 25).

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

Clinical classification (AHRQ CCSR):MBD001 — Schizophrenia spectrum and other psychotic 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 (Psychosis, Except Schizophrenia) for risk-adjusted payment.

F22 — Delusional disorders, F23 — Brief psychotic disorder, F24 — Shared psychotic disorder, F29 — Unspecified psychosis not due to a substance or known physiological condition, F30.2 — Manic episode, severe with psychotic symptoms, F31.2 — Bipolar disorder, current episode manic severe with psychotic features, F31.5 — Bipolar disorder, current episode depressed, severe, with psychotic features, F31.64 — Bipolar disorder, current episode mixed, severe, with psychotic features, F32.3 — Major depressive disorder, single episode, severe with psychotic features, F33.3 — Major depressive disorder, recurrent, severe with psychotic symptoms, F53.1 — Puerperal psychosis

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.

Schizophrenia, Personality Disorders; Anorexia/Bulimia Nervosa, Bipolar Disorders without Psychosis, Major Depression, Moderate or Severe, without Psychosis

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Schizophrenia spectrum and other psychotic disorders).

F19.959 — Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified, F20.0 — Paranoid schizophrenia, F20.1 — Disorganized schizophrenia, F20.2 — Catatonic schizophrenia, F20.3 — Undifferentiated schizophrenia, F20.5 — Residual schizophrenia, F20.81 — Schizophreniform disorder, F20.89 — Other schizophrenia, F20.9 — Schizophrenia, unspecified, F21 — Schizotypal disorder, F22 — Delusional disorders, F23 — Brief psychotic disorder, F24 — Shared psychotic disorder, F25.0 — Schizoaffective disorder, bipolar type, F25.1 — Schizoaffective disorder, depressive type, F25.8 — Other schizoaffective disorders, F25.9 — Schizoaffective disorder, unspecified, F29 — Unspecified psychosis not due to a substance or known physiological condition, F53 — Mental and behavioral disorders associated with the puerperium, not elsewhere classified, F53.1 — Puerperal psychosis, +83 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Psychosis, psychotic”, “Menopause, menopausal”, “Schizophrenia, schizophrenic”, …; these codes share that main term but sit in a different category of the Tabular List.

F20.89 — Other schizophrenia (simple), F20.9 — Schizophrenia, unspecified, F21 — Schizotypal disorder (latent), F22 — Delusional disorders (delusional), F23 — Brief psychotic disorder (acute), F24 — Shared psychotic disorder (shared), F25.0 — Schizoaffective disorder, bipolar type (cyclic), F25.1 — Schizoaffective disorder, depressive type (schizoaffective, depressive type), F25.8 — Other schizoaffective disorders (mixed schizophrenic and affective), F25.9 — Schizoaffective disorder, unspecified (schizoaffective), F29 — Unspecified psychosis not due to a substance or known physiological condition, F30.2 — Manic episode, severe with psychotic symptoms (mania, manic), F30.8 — Other manic episodes (hypomanic), F31.89 — Other bipolar disorder (mania, manic, recurrent type), F32.2 — Major depressive disorder, single episode, severe without psychotic features (depression, agitated), F32.3 — Major depressive disorder, single episode, severe with psychotic features (reactive, depressive), F32.89 — Other specified depressive episodes (depression), F33.3 — Major depressive disorder, recurrent, severe with psychotic symptoms (reactive, depressive, recurrent), F33.8 — Other recurrent depressive disorders (depression, recurrent episode), F33.9 — Major depressive disorder, recurrent, unspecified (depression, agitated, recurrent episode), +71 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.

Blood Glucose Test

Contextual Map

Every relationship of F28 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 F28 with these 3 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 152 — Psychosis, Except Schizophrenia [CMS-HCC]: “Psychosis, Except Schizophrenia — supersedes HCC 153 (Personality Disorders; Anorexia/Bulimia Nervosa), HCC 154 (Bipolar Disorders without Psychosis), HCC 155 (Major Depression, Moderate or Severe, without Psychosis)”— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

  • MDC 19 — Mental Diseases and Disorders[MDC crossing]: “Mental Diseases and 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.”— CMS MS-DRG Definitions Manual · FY2026
  • MDC 25 — Human Immunodeficiency Virus Infections[MDC crossing]: “Human Immunodeficiency Virus Infections — 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.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Disorder (of), schizophrenia spectrum and other psychotic disorder, specified NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Hallucinosis (chronic)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Insanity, insane, confusional[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Menopause, menopausal (asymptomatic) (state), psychosis NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Psychosis, psychotic, hallucinatory, chronic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Psychosis, psychotic, involutional[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Psychosis, psychotic, nonorganic, specified NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Schizophrenia, schizophrenic, spectrum and other psychotic disorder, specified NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

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
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 psychotic disorder not due to a substance or known physiological condition

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.