F11.121 ICD-10-CM Code: Opioid abuse with intoxication delirium
F11.121 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)
F11.121
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOpioid abuse with intoxication delirium
A person is abusing opioids, is intoxicated, and is experiencing delirium (confusion, disorientation, and altered consciousness).
Buddy Insight
Opioid abuse with intoxication delirium is a medical emergency indicating acute confusion, disorientation, and altered consciousness caused by opioid intoxication in a patient with an abuse pattern.
CMS-HCC V28
MappedHCC 137
Coefficient HCC 137: 0.424 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 082
Code-level coefficient reference
ESRD/PACE
MappedHCC 55
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for F11.121. Check the code and parent instructions in the Code Book.
Excludes 2
Official- symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99
Related Codes
Includes
Official- disorders of psychological developmentInherited from F01-F99
Excludes 1
Official- opioid dependence (F11.2-)Inherited from F11.1
- opioid use, unspecified (F11.9-)Inherited from F11.1
Code First
OfficialNo Code First sequencing instructions are included in this display for F11.121. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F11.121. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F11.121. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is F11.121 an HCC code?
Yes. F11.121 (Opioid abuse with intoxication delirium) maps to HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.424. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: F11.121 is billable and maps to V28 HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- F11.121
- Description
- Opioid abuse with intoxication delirium
- HCC (V28)
- HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
- RAF reference coefficient
- 0.424
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work F11.121 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F11.121
For F11.121, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Coder workflow notes
Get the V28 mapping + MEAT cheat sheet
One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.
Free PDF. No card. Unsubscribe anytime.
What This Code Means
F11.121 is the ICD-10-CM diagnosis code for opioid abuse with intoxication delirium. A person is abusing opioids, is intoxicated, and is experiencing delirium (confusion, disorientation, and altered consciousness). F11.121 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering mental and behavioral disorders due to psychoactive substance use (f10-f19).
Under the CMS-HCC V28 risk adjustment model, F11.121 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a source-labeled community, non-dual, aged reference coefficient of 0.424. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Delirium is a serious complication; ensure documentation supports the presence of confusion and disorientation. For F11.121, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for F11.121 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Delirium is a serious complication; ensure documentation supports the presence of confusion and disorientation
- •This code indicates a more severe presentation than uncomplicated intoxication and may warrant higher level of care
Clinical Significance
Opioid abuse with intoxication delirium is a medical emergency indicating acute confusion, disorientation, and altered consciousness caused by opioid intoxication in a patient with an abuse pattern. This presentation often requires emergency department evaluation and may indicate overdose or poly-substance use, carrying significant morbidity and mortality risk.
Documentation Requirements
- ✓Provider documentation of opioid abuse
- ✓Documentation of active intoxication
- ✓Delirium symptoms documented (acute confusion, disorientation, fluctuating consciousness, agitation)
- ✓Vital signs including respiratory rate and oxygen saturation
- ✓Assessment for overdose and naloxone administration if applicable
- ✓Mental status examination findings
- ✓Toxicology screen results if obtained
Commonly Confused Codes
- •F11.120: Opioid abuse with intoxication, uncomplicated: use when intoxication is present WITHOUT delirium
- •F11.122: Opioid abuse with intoxication with perceptual disturbance: use when perceptual changes occur without full delirium
- •F11.221: Opioid dependence with intoxication delirium: use when dependence (not abuse) is documented
- •F05: Delirium due to known physiological condition: use when delirium is NOT substance-induced