ICD-10 R11.16
Billable / Specific HCC v28: 55Cannabis hyperemesis syndrome
About ICD-10-CM R11.16
ICD-10-CM code R11.16 represents Cannabis hyperemesis syndrome. This is a billable/specific code in the Symptoms, Signs, and Abnormal Findings chapter (block R11). The 2026 edition of ICD-10-CM R11.16 became effective on October 1, 2025.
Coding Tips for R11.16
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
R11.16 is a CMS-HCC v28 risk-adjustment code (category 55). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under R11.16. Per CMS ICD-10-CM Tabular 2026.
- Cannabinoid hyperemesis syndrome
Coding Notes
Code Also
- cannabis abuse (F12.1-)
- cannabis dependence (F12.2-)
- cannabis use, unspecified (F12.92-, F12.93, F12.95-, F12.98-, F12.99)
- manifestations, such as:
- dehydration (E86.0)
- electrolyte imbalance (E87.8}
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for R11.16
Local Coverage Determinations (LCDs) from CMS MACs that list R11.16 as a covered diagnosis.
Showing top 10 of 195 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing R11.16.
5 Medicare
CPT Codes Commonly Billed with R11.16
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Codes Adjacent To R11.16
Other codes in section R10-R19 (Symptoms and signs involving the digestive system and abdomen).
ICD-10 R11.16, Billing FAQ
Is ICD-10 code R11.16 billable? +
Yes, R11.16 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to R11.16? +
ICD-10 R11.16 includes: Cannabinoid hyperemesis syndrome.
Does R11.16 affect Medicare Advantage HCC risk adjustment? +
Yes. R11.16 maps to CMS-HCC v28 category 55. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team