F11.122
BillableOpioid abuse with intoxication with perceptual disturbance
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F11.122 an HCC code?
Yes. F11.122 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Dependence under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for F11.122
For F11.122 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- 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
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed F11.122 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F11.122 is the ICD-10-CM diagnosis code for opioid abuse with intoxication with perceptual disturbance. A person is abusing opioids, is intoxicated, and is experiencing perceptual disturbances such as hallucinations or distorted sensory experiences. F11.122 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, F11.122 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe (HCC 137) with a community, non-dual, aged base RAF weight of 0.358. Under the older CMS-HCC V24 model, F11.122 maps to Drug/Alcohol Dependence (HCC 55) with a community, non-dual, aged base RAF weight of 0.334. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Document the specific perceptual disturbances (visual, auditory, tactile hallucinations) to support this code. Because F11.122 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, and MEAT documentation criteria for F11.122 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific perceptual disturbances (visual, auditory, tactile hallucinations) to support this code
- •Distinguish from F11.121 (delirium) which involves more global confusion rather than isolated perceptual changes
Clinical Significance
Opioid abuse with intoxication with perceptual disturbance identifies cases where opioid intoxication causes hallucinations or sensory distortions without meeting full delirium criteria. This is clinically distinct from delirium and may include visual illusions, tactile hallucinations, or auditory disturbances. It indicates a complicated intoxication requiring enhanced monitoring.
Documentation Requirements
- ✓Provider documentation of opioid abuse
- ✓Documentation of active intoxication
- ✓Specific perceptual disturbances described (visual, auditory, tactile hallucinations or illusions)
- ✓Assessment confirming perceptual disturbances without full delirium
- ✓Mental status examination
- ✓Type of opioid and route of use if documented
- ✓Monitoring and treatment plan