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F11.129 ICD-10-CM Code: Opioid abuse with intoxication, unspecified

F11.129 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 · HCC coding software

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Code lookupF11.129

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)

F11.129

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Opioid abuse with intoxication, unspecified

A person is abusing opioids and is intoxicated, but the specific type of intoxication complication (such as delirium or hallucinations) is not documented or specified.

Buddy the Bee presenting code insight

Buddy Insight

Opioid abuse with intoxication, unspecified is used when opioid intoxication is present in the context of abuse but the specific type of intoxication (uncomplicated, with delirium, or with perceptual disturbance) cannot be determined.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

HCC 137

Code-level coefficient reference

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 082

Code-level coefficient reference

ESRD/PACE

HCC 55

Code-level coefficient reference

RXHCC

N/A

—

Not mapped

Code Book Path

Official
F11.1Opioid abuseF11.12Opioid abuse with intoxicationF11.129Opioid abuse with intoxication, unspecified

Inclusion Terms

Official

No inclusion terms are included in this display for F11.129. 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

Official
F11.120Opioid abuse with intoxication, uncomplicatedF11.121Opioid abuse with intoxication deliriumF11.122Opioid abuse with intoxication with perceptual disturbance

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

Official

No Code First sequencing instructions are included in this display for F11.129. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F11.129. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F11.129. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
Provider documentation of opioid abuse pattern
Documentation of current opioid intoxication
Clinical signs of intoxication (miosis, sedation, respiratory changes)
Statement that specific intoxication complications cannot be determined or are not documented

MEAT Support

HCC Buddy guidance
Provider documentation of opioid abuse pattern
Documentation of current opioid intoxication
Clinical signs of intoxication (miosis, sedation, respiratory changes)
Statement that specific intoxication complications cannot be determined or are not documented

Audit Caution

HCC Buddy guidance
Defaulting to this unspecified code without querying the provider for specificity
Using this code when documentation clearly supports one of the more specific intoxication codes
Confusing the 'unspecified' intoxication with 'uncomplicated' intoxication — they are different concepts
Not recognizing that additional documentation review may reveal specific complications

Common Mistakes

HCC Buddy guidance
F11.120 — Opioid abuse with intoxication, uncomplicated: use when it is clear there are no complications
F11.121 — Opioid abuse with intoxication delirium: use when delirium is documented
F11.122 — Opioid abuse with intoxication with perceptual disturbance: use when perceptual disturbances are documented
F11.929 — Opioid use, unspecified with intoxication, unspecified: use when the use pattern is also unspecified

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 F11.129 an HCC code?

Yes. F11.129 (Opioid abuse with intoxication, unspecified) 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: F11.129 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
F11.129
Description
Opioid abuse with intoxication, unspecified
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

V28HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
0.424
ESRDHCC 55, Substance Use Disorder/Moderate/Severe/Substance Use with Complications
Not separately weighted

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 F11.129 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F11.129

For F11.129, 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

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What This Code Means

F11.129 is the ICD-10-CM diagnosis code for opioid abuse with intoxication, unspecified. A person is abusing opioids and is intoxicated, but the specific type of intoxication complication (such as delirium or hallucinations) is not documented or specified. F11.129 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, F11.129 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. No V24 mapping is shown for F11.129; use the applicable model and payment year when reviewing the V28 mapping. 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.

Use this code only when intoxication is present but details about delirium or perceptual disturbances are unclear. For F11.129, 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 F11.129 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Use this code only when intoxication is present but details about delirium or perceptual disturbances are unclear
  • •Review documentation to determine if F11.120, F11.121, or F11.122 would be more specific

Clinical Significance

Opioid abuse with intoxication, unspecified is used when opioid intoxication is present in the context of abuse but the specific type of intoxication (uncomplicated, with delirium, or with perceptual disturbance) cannot be determined. This code should prompt a query for more specific documentation when possible.

Documentation Requirements

  • ✓Provider documentation of opioid abuse pattern
  • ✓Documentation of current opioid intoxication
  • ✓Clinical signs of intoxication (miosis, sedation, respiratory changes)
  • ✓Statement that specific intoxication complications cannot be determined or are not documented

Commonly Confused Codes

  • •F11.120: Opioid abuse with intoxication, uncomplicated: use when it is clear there are no complications
  • •F11.121: Opioid abuse with intoxication delirium: use when delirium is documented
  • •F11.122: Opioid abuse with intoxication with perceptual disturbance: use when perceptual disturbances are documented
  • •F11.929: Opioid use, unspecified with intoxication, unspecified: use when the use pattern is also unspecified

Child Codes

F11.120Opioid abuse with intoxication, uncomplicated
HCC 137
F11.121Opioid abuse with intoxication delirium
HCC 137
F11.122Opioid abuse with intoxication with perceptual disturbance
HCC 137
F11.129Opioid abuse with intoxication, unspecified
HCC 137

Code Hierarchy

└F11Opioid related disorders└F11.1Opioid abuse└F11.12Opioid abuse with intoxication└F11.129Opioid abuse with intoxication, unspecified
└F11.129Opioid abuse with intoxication, unspecified

For F11.129, 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.

F11.129 maps to CMS-HCC V28 category 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for F11.129. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

Work F11.129 in HCC Buddy

Open F11.129 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

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