Other psychotic disorder not due to a substance or known physiological condition
In Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F20-F29), chapter 5: Mental, Behavioral and Neurodevelopmental Disorders
- F28 is billable and valid on claims for FY 2027. If the record has more detail, check the other codes under F20-F29 below.
- As a secondary diagnosis it is not a CC or MCC, so it doesn't raise the MS-DRG payment.
- Counts toward HCC 152 (Psychosis, Except Schizophrenia) in the Medicare Advantage risk model (CMS-HCC V28).
- AHRQ's Chronic Condition Indicator classes it as not chronic (an acute or short-term condition).
Also indexed as: Disorder, schizophrenia spectrum and other psychotic disorder, specified NEC; Hallucinosis; Insanity, confusional; Menopause, psychosis NEC; Psychosis, hallucinatory, chronic; Psychosis, involutional; Psychosis, nonorganic, specified NEC; Schizophrenia, spectrum and other psychotic disorder, specified NEC
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Instructional notes
Includes: conditions that are coded here
- Chronic hallucinatory psychosis
- Other specified schizophrenia spectrum and other psychotic disorder
Official coding guidelines
From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.
Covers psychological pain disorders, substance use, abuse, dependence and remission, factitious disorder including Munchausen by proxy, and dementia severity.
- Pain disorders related to psychological factors (page 43)
- Mental and behavioral disorders due to psychoactive substance use (page 43)
- Factitious Disorder (page 44)
- Dementia (page 45)
Other codes under F20-F29
Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F20-F29)
- F20Schizophrenia
- F21Schizotypal disorder
- F22Delusional disorders
- F23Brief psychotic disorder
- F24Shared psychotic disorder
- F25Schizoaffective disorders
- F28Other psychotic disorder not due to a substance or known physiological condition(this code)
- F29Unspecified psychosis not due to a substance or known physiological condition
F28 MS-DRGs
As the principal diagnosis, F28 groups to MS-DRG 885, 974, 975, or 976 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.
Related conditions
Grouped by AHRQ's Clinical Classifications Software Refined (CCSR), which sorts every diagnosis code into clinically meaningful categories.
F28 is in Schizophrenia spectrum and other psychotic disorders (MBD001, its default category), with 103 codes. Others in it:
- F06.0 Psychotic disorder with hallucinations due to known physiological condition
- F06.1 Catatonic disorder due to known physiological condition
- F06.2 Psychotic disorder with delusions due to known physiological condition
- F10.150 Alcohol abuse with alcohol-induced psychotic disorder with delusions
- F10.151 Alcohol abuse with alcohol-induced psychotic disorder with hallucinations
- F10.159 Alcohol abuse with alcohol-induced psychotic disorder, unspecified
- F10.250 Alcohol dependence with alcohol-induced psychotic disorder with delusions
- F10.251 Alcohol dependence with alcohol-induced psychotic disorder with hallucinations
Medicare coverage articles listing F28
These 14 Medicare billing and coding articles list F28 as a diagnosis that supports medical necessity for the services they cover. From the CMS Medicare Coverage Database; check your own contractor's article before billing.
- Psychiatric Inpatient Hospitalization (3 contractors)
- Psychiatric Partial Hospitalization Programs (2 contractors)
- Psychiatry and Psychology Services (2 contractors)
- CT of the Head
- Controlled Substance Monitoring and Drugs of Abuse Testing
- Home Health - Psychiatric Care
- MRI and CT Scans of the Head and Neck
- Monitored Anesthesia Care
- Outpatient Psychiatry and Psychology Services
- Oximetry Services
And 4 more.
About the condition
Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.
Psychotic Disorders
Psychotic disorders are severe mental disorders that cause abnormal thinking and perceptions. People with psychoses lose touch with reality. Two of the main symptoms are delusions and hallucinations. Delusions are false beliefs, such as thinking that someone is plotting against you or that the TV is sending you secret messages. Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there.
Read more about psychotic disorders on MedlinePlusCode history
Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.
ICD-9-CM equivalent
Legacy crosswalk from the CMS General Equivalence Mappings (last updated 2018).
- 298.9 Unspecified psychosis (approximate)