2026 ICD-10-CM Diagnosis Code R11.16Cannabis hyperemesis syndrome

ICD-10-CM Codes›R00–R99›R10-R19›R11

ICD-10-CM R11.16
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

R11.16 is a billable ICD-10-CM diagnosis code for cannabis hyperemesis syndrome. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 391 through 392. As a symptom code, it should not be used as a principal diagnosis once a related definitive diagnosis has been established.

For Medicare Advantage risk adjustment, R11.16 maps to CMS-HCC Category 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications) under the V28 model, adding a risk factor of about 0.424 for a community, non-dual, aged beneficiary in payment year 2026.

Code Identity

ICD-10-CM Code
R11.16
Billable Status
Yes — Valid for Submission
Code Describes
Cannabis hyperemesis syndrome
Short Description
Cannabis hyperemesis syndrome
Same as the full description in the CMS dataset.
Parent Code
R11.1
Vomiting

Code Classification

ChapterR00–R99Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
SectionR10-R19Symptoms and signs involving the digestive system and abdomen
CategoryR11Nausea and vomiting
This CodeR11.16Cannabis hyperemesis syndrome

Medicare Risk Adjustment (HCC)Billing

R11.16 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 2026.

CMS-HCC V28 Category (Payment Model)
HCC 137— Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
Payment HCC · PY 2026 one of 308 ICD-10-CM codes in this category
Risk Adjustment Factor (RAF) Weight
+0.424
community, non-dual, aged · ranges 0.297–0.502 across segments
Hierarchy
Superseded by HCC 135 and HCC 136
a more severe related category takes the payment when both are reported
Prior Model (CMS-HCC V24)
Not mapped under V24
this diagnosis newly risk-adjusts under the V28 model
Other CMS Models
PACE (CMS-HCC V22): HCC 55 · ESRD (V21): HCC 55 · ESRD (V24): HCC 55
ESRD V21 weights: 0.048 dialysis, 0.112–0.352 functioning graft · ESRD V24 weights: 0.111 dialysis, 0.172–0.416 functioning graft
Part D (RxHCC)
Not mapped
R11.16 does not risk-adjust in the RxHCC prescription drug model

Source: CMS Payment Year 2026 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.

Tabular List NotesGuidance

Coding notes and annotation back-references applicable to this code.

Inclusion Terms

  • Cannabinoid hyperemesis syndrome

Code Also

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical InformationClinical

  • Postoperative Nausea and Vomiting

    emesis and queasiness occurring after anesthesia.

  • Vomiting

    the forcible expulsion of the contents of the stomach through the mouth.

  • Vomiting, Anticipatory

    vomiting caused by expectation of discomfort or unpleasantness.

Code History & ChangesHistory

New Code R11.16 was added to the ICD-10-CM code set for FY 2026, effective October 1, 2025.

Replacement R11.16 replaces the following previously assigned code(s):

  • R11.10 - Vomiting, unspecified
FY 2026AddedAdded to the ICD-10-CM code setEffective October 1, 2025.
FY 2026CurrentRevised in the current code setEffective October 1, 2025 through September 30, 2026.

Questions About R11.16Overview

What is the ICD-10 code for cannabis hyperemesis syndrome?

The ICD-10-CM code for cannabis hyperemesis syndrome is R11.16 (sometimes written as R1116). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

Is R11.16 (Vomiting) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report cannabis hyperemesis syndrome on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does R11.16 group to?

When cannabis hyperemesis syndrome is the principal diagnosis on an inpatient stay, it groups to MS-DRG 391, 392, with relative weights from 0.7796 to 1.2683 depending on complications. Higher weights mean higher Medicare reimbursement.

Can R11.16 be a principal diagnosis?

Use it with care. This is a symptom code, so once a definitive diagnosis explaining the cannabis hyperemesis syndrome is established, that condition takes the principal position instead.

What HCC is R11.16?

R11.16 (cannabis hyperemesis syndrome) maps to CMS-HCC Category 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications), commonly written as HCC 137, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. 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 R11.16 risk-adjust for Medicare Advantage payment?

Yes. When documented and reported on a Medicare Advantage encounter, R11.16 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 0.502 depending on the payment segment). A more severe related category (HCC 135 and HCC 136) supersedes it when both are reported. See the full factor table on the HCC 137 category page.