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F11.229 ICD-10-CM Code: Opioid dependence with intoxication, unspecified

F11.229 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

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

F11.229

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

Opioid dependence with intoxication, unspecified

A person is dependent on opioids and is currently intoxicated, but the specific type of intoxication symptoms is not documented or specified.

Buddy the Bee presenting code insight

Buddy Insight

Opioid dependence with intoxication, unspecified captures cases where a dependent patient is intoxicated but the specific nature of the intoxication (uncomplicated, with delirium, or with perceptual disturbance) is not documented.

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
F11.2Opioid dependence
F11.22Opioid dependence with intoxication
F11.229Opioid dependence with intoxication, unspecified

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F11.229 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F11.229 in this effective period.

Related Child Codes

Official
F11.220Opioid dependence with intoxication, uncomplicated
F11.221Opioid dependence with intoxication delirium
F11.222Opioid dependence with intoxication with perceptual disturbance

Includes

Official

ICD-10-CM does not list Includes notes for F11.229 in this effective period.

Excludes 1

Official
  • opioid dependence with withdrawal (F11.23)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F11.229 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F11.229 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F11.229 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Provider documentation of opioid dependence
Documentation of current intoxication
Clinical signs of intoxication present
Documentation supporting why specific intoxication type cannot be determined

MEAT Support

HCC Buddy guidance
Provider documentation of opioid dependence
Documentation of current intoxication
Clinical signs of intoxication present
Documentation supporting why specific intoxication type cannot be determined

Audit Caution

HCC Buddy guidance
Defaulting to unspecified when documentation supports a more specific code
Confusing 'unspecified' with 'uncomplicated' — they are different concepts
Not reviewing the full clinical encounter for clues about the intoxication presentation
Using this code when the use pattern is abuse rather than dependence

Common Mistakes

HCC Buddy guidance
F11.220 — Opioid dependence with intoxication, uncomplicated: use when it is clear there are no complications
F11.221 — Opioid dependence with intoxication delirium: use when delirium is documented
F11.222 — Opioid dependence with intoxication with perceptual disturbance: use when perceptual changes 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 F11.229 an HCC code?

Yes. F11.229 (Opioid dependence 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: F11.229 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
F11.229
Description
Opioid dependence 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 F11.229 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for F11.229

For F11.229 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 F11.229 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F11.229 is the ICD-10-CM diagnosis code for opioid dependence with intoxication, unspecified. A person is dependent on opioids and is currently intoxicated, but the specific type of intoxication symptoms is not documented or specified. F11.229 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, F11.229 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 F11.229; use the applicable model and payment year when reviewing the V28 mapping. 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. 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 perceptual disturbances or other specific symptoms are not documented. Because F11.229 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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 F11.229 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 perceptual disturbances or other specific symptoms are not documented
  • •This is a less specific code; try to obtain more detailed documentation when possible

Clinical Significance

Opioid dependence with intoxication, unspecified captures cases where a dependent patient is intoxicated but the specific nature of the intoxication (uncomplicated, with delirium, or with perceptual disturbance) is not documented. This should prompt a provider query when possible to improve documentation specificity.

Documentation Requirements

  • ✓Provider documentation of opioid dependence
  • ✓Documentation of current intoxication
  • ✓Clinical signs of intoxication present
  • ✓Documentation supporting why specific intoxication type cannot be determined

Commonly Confused Codes

  • •F11.220: Opioid dependence with intoxication, uncomplicated: use when it is clear there are no complications
  • •F11.221: Opioid dependence with intoxication delirium: use when delirium is documented
  • •F11.222: Opioid dependence with intoxication with perceptual disturbance: use when perceptual changes are documented
  • •F11.929: Opioid use, unspecified with intoxication, unspecified: use when the use pattern is also unspecified

Child Codes

F11.220Opioid dependence with intoxication, uncomplicated
HCC 137
F11.221Opioid dependence with intoxication delirium
HCC 137
F11.222Opioid dependence with intoxication with perceptual disturbance
HCC 137
F11.229Opioid dependence with intoxication, unspecified
HCC 137

Code Hierarchy

└F11Opioid related disorders└F11.2Opioid dependence└F11.22Opioid dependence with intoxication└F11.229Opioid dependence with intoxication, unspecified
└F11.229Opioid dependence with intoxication, unspecified

Because F11.229 maps to an HCC category, the documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment.

F11.229 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 F11.229. 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.

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