2027 ICD-10-CM Diagnosis Code F14.259Cocaine dependence with cocaine-induced psychotic disorder, unspecified
ICD-10-CM Codes›F01–F99›F10-F19›F14
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 135
- Chronic Condition
F14.259 is a billable ICD-10-CM diagnosis code for cocaine dependence with cocaine-induced psychotic disorder, unspecified. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 894 through 897. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 11 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Schizophrenia spectrum and other psychotic disorders and Stimulant-related disorders.
For Medicare Advantage risk adjustment, F14.259 maps to CMS-HCC Category 135 (Drug Use with Psychotic Complications) under the V28 model, adding a risk factor of about 0.424 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
F14.259 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to F14.259: its own notes plus those printed at F14.2, F14, and Chapter 5. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- disorders of psychological development
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name F14.259, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming F14.259: they are not reported together with it, unless the two conditions are unrelated.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Disorder (of) See Also: Disease;
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Cocaine-Related Disorders
disorders related or resulting from use of cocaine.
Patient EducationClinical
Cocaine
Cocaine is a very addictive drug that is made from leaves of the coca plant found in South America. It is mostly available as an illegal drug that some people use to get high. In rare cases, it is also used as a prescription drug for for anesthesia during certain surgeries.
The full article covers:
- What is cocaine?
- How do people use cocaine?
- What are the short-term effects of cocaine?
- What are the long-term effects of cocaine?
- Can a person overdose on cocaine?
- What are the treatments for cocaine use disorder?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert F14.259 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About F14.259Overview
Is F14.259 (Cocaine dependence with cocaine-induced psychotic disorder) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report cocaine dependence with cocaine-induced psychotic disorder, unspecified on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does F14.259 group to?
When cocaine dependence with cocaine-induced psychotic disorder, unspecified is the principal diagnosis on an inpatient stay, it groups to MS-DRG 894, 897, 895, 896, with relative weights from 0.6272 to 1.6610 depending on complications. Higher weights mean higher Medicare reimbursement.
Is F14.259 a CC or MCC?
CMS lists F14.259 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 11 closely related codes in its exclusion list.
Can F14.259 be reported with a code from F14.1?
Not as a rule. The Excludes1 note at F14.2, which applies to F14.259, lists "cocaine abuse (F14.1-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What is the ICD-9 equivalent of F14.259?
Under the General Equivalence Mappings, cocaine dependence with cocaine-induced psychotic disorder, unspecified converts to ICD-9-CM 292.89 (drug mental disorder NEC) and 304.20 (cocaine depend-unspec). The mapping is approximate, so confirm the match fits the documentation.
What HCC is F14.259?
F14.259 (cocaine dependence with cocaine-induced psychotic disorder, unspecified) maps to CMS-HCC Category 135 (Drug Use with Psychotic Complications), commonly written as HCC 135, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 54 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does F14.259 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, F14.259 adds a risk adjustment factor of about 0.424 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.297 to 1.181 depending on the payment segment). HCC 135 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 135 category page.
