F12.221 ICD-10-CM Code: Cannabis dependence with intoxication delirium
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)
F12.221
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceCannabis dependence with intoxication delirium
A person dependent on cannabis who is currently intoxicated and experiencing delirium, a state of confusion and disorientation.
Buddy Insight
Cannabis dependence with intoxication delirium represents a severe acute presentation where a dependent patient develops confusion, disorientation, and altered consciousness during cannabis intoxication.
CMS-HCC V28
MappedHCC 137
RAF 0.358
CMS-HCC V24
MappedHCC 55
RAF 0.334
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 55
RAF 0.0
RXHCC
00
RAF 0
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for F12.221 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for F12.221 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for F12.221 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for F12.221 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for F12.221 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for F12.221 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for F12.221 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is F12.221 an HCC code?
Yes. F12.221 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 F12.221
For F12.221to 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 F12.221 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
F12.221 is the ICD-10-CM diagnosis code for cannabis dependence with intoxication delirium. A person dependent on cannabis who is currently intoxicated and experiencing delirium, a state of confusion and disorientation. F12.221 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, F12.221 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, F12.221 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.
Delirium is a serious acute mental state; ensure documentation clearly describes the confusion and disorientation. Because F12.221 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 F12.221 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Delirium is a serious acute mental state; ensure documentation clearly describes the confusion and disorientation
- •This code indicates active intoxication with severe cognitive symptoms requiring immediate clinical attention
Clinical Significance
Cannabis dependence with intoxication delirium represents a severe acute presentation where a dependent patient develops confusion, disorientation, and altered consciousness during cannabis intoxication. This is a clinical emergency requiring close monitoring. Delirium in the context of cannabis dependence may indicate high-potency cannabis use or concurrent medical conditions that exacerbate intoxication effects. The severity of this presentation drives increased healthcare utilization.
Documentation Requirements
- ✓Documentation of cannabis dependence criteria
- ✓Acute delirium findings: confusion, disorientation, altered consciousness, fluctuating attention
- ✓Temporal relationship to recent cannabis use
- ✓Mental status examination documenting delirium
- ✓Vital signs and monitoring documentation
- ✓Exclusion of other causes of delirium (metabolic, infectious, medication-related)
Commonly Confused Codes
- •F12.220 — Cannabis dependence with intoxication, uncomplicated; use when no delirium is present
- •F12.222 — Cannabis dependence with intoxication with perceptual disturbance; use when perceptual changes occur without full delirium
- •F12.250-F12.259 — Cannabis dependence with psychotic disorder; use when psychosis persists beyond intoxication
- •F05 — Delirium due to known physiological condition; use when delirium is not substance-induced