What is ICD-10 code F11.922?

F11.922 is the ICD-10-CM diagnosis code for Opioid use, unspecified with intoxication with perceptual disturbance. Opioid intoxication accompanied by distorted perceptions such as seeing, hearing, or feeling things that aren't there, without meeting full delirium criteria. F11.922 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F11.922 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F11.922 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F11.922 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does F11.922 map to under V28?

F11.922 maps to CMS-HCC V28 HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM F11.922: Opioid use, unspecified

F11.922 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

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Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupF11.922Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

F11.922

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

Opioid use, unspecified with intoxication with perceptual disturbance

Opioid intoxication accompanied by distorted perceptions such as seeing, hearing, or feeling things that aren't there, without meeting full delirium criteria.

Buddy Insight

Opioid use, unspecified with intoxication with perceptual disturbance captures hallucinations or sensory distortions during opioid intoxication in a patient whose use pattern is not classified.

CMS-HCC V28

Mapped

HCC 137

Drug Use Disorder, Moderate/S...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 082

HHS-HCC 082 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 55

Substance Use Disorder/Modera...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F11.9Opioid use, unspecified

F11.92Opioid use, unspecified with intoxication

F11.922Opioid use, unspecified with intoxication with perceptual disturbance

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F11.922 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F11.922 in this effective period.

Related Child Codes

Official

F11.920Opioid use, unspecified with intoxication, uncomplicated

F11.921Opioid use, unspecified with intoxication delirium

F11.929Opioid use, unspecified with intoxication, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for F11.922 in this effective period.

Excludes 1

Official

opioid use, unspecified with withdrawal (F11.93)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F11.922 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F11.922 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F11.922 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of opioid intoxication

Specific perceptual disturbances described (type of hallucinations or sensory distortions)

Assessment confirming perceptual disturbances without full delirium criteria

Assessment for poly-substance use

MEAT Support

HCC Buddy guidance

Documentation of opioid intoxication

Specific perceptual disturbances described (type of hallucinations or sensory distortions)

Assessment confirming perceptual disturbances without full delirium criteria

Assessment for poly-substance use

Audit Caution

HCC Buddy guidance

Confusing perceptual disturbance (isolated sensory changes) with delirium (global cognitive disruption)

Using the uncomplicated code when perceptual disturbances are documented

Not querying the provider about the use pattern when history becomes available

Failing to consider poly-substance use as a cause of the perceptual disturbances

Common Mistakes

HCC Buddy guidance

F11.921 — Opioid use, unspecified with intoxication delirium: use when full delirium (not just perceptual changes) is present

F11.920 — Opioid use, unspecified with intoxication, uncomplicated: use when no perceptual disturbances or delirium present

F11.122 — Opioid abuse with intoxication with perceptual disturbance: use when abuse is documented

F11.222 — Opioid dependence with intoxication with perceptual disturbance: use when dependence is documented

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 F11.922 an HCC code?

Yes. F11.922 (Opioid use, unspecified with intoxication with perceptual disturbance) 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: F11.922 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: F11.922
Description: Opioid use, unspecified with intoxication with perceptual disturbance
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 F11.922 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for F11.922

For F11.922 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 F11.922 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F11.922 is the ICD-10-CM diagnosis code for opioid use, unspecified with intoxication with perceptual disturbance. Opioid intoxication accompanied by distorted perceptions such as seeing, hearing, or feeling things that aren't there, without meeting full delirium criteria. F11.922 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, F11.922 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 F11.922; 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.

Document specific perceptual disturbances (visual, auditory, or tactile hallucinations). Because F11.922 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 F11.922 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document specific perceptual disturbances (visual, auditory, or tactile hallucinations)
•Differentiate from F11.921 which includes delirium; this code focuses on perceptual changes only

Clinical Significance

Opioid use, unspecified with intoxication with perceptual disturbance captures hallucinations or sensory distortions during opioid intoxication in a patient whose use pattern is not classified. Perceptual disturbances from opioids may include visual illusions, tactile hallucinations, or auditory distortions, and may suggest poly-substance use or high-dose exposure.

Documentation Requirements

✓Documentation of opioid intoxication
✓Specific perceptual disturbances described (type of hallucinations or sensory distortions)
✓Assessment confirming perceptual disturbances without full delirium criteria
✓Assessment for poly-substance use
✓Mental status examination
✓Treatment and monitoring plan

Commonly Confused Codes

•F11.921: Opioid use, unspecified with intoxication delirium: use when full delirium (not just perceptual changes) is present
•F11.920: Opioid use, unspecified with intoxication, uncomplicated: use when no perceptual disturbances or delirium present
•F11.122: Opioid abuse with intoxication with perceptual disturbance: use when abuse is documented
•F11.222: Opioid dependence with intoxication with perceptual disturbance: use when dependence is documented