F12.222
BillableCannabis dependence 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 F12.222 an HCC code?
Yes. F12.222 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 F12.222
For F12.222 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 F12.222 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F12.222 is the ICD-10-CM diagnosis code for cannabis dependence with intoxication with perceptual disturbance. A person dependent on cannabis who is currently intoxicated and experiencing distorted perceptions, such as seeing or hearing things that aren't there. F12.222 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, F12.222 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, F12.222 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 (hallucinations, illusions, or depersonalization) when present. Because F12.222 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 F12.222 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 (hallucinations, illusions, or depersonalization) when present
- •This code indicates active intoxication with psychotic-like symptoms but without full psychotic disorder criteria
Clinical Significance
Cannabis dependence with intoxication with perceptual disturbance identifies a dependent patient experiencing hallucinations, illusions, or altered perceptual experiences during acute cannabis intoxication. This differs from psychotic disorder in that the patient typically maintains awareness that experiences are drug-related and symptoms resolve when intoxication clears. High-potency cannabis products are increasingly associated with these perceptual disturbances.
Documentation Requirements
- ✓Documentation of cannabis dependence criteria
- ✓Description of specific perceptual disturbances (hallucinations, illusions, depersonalization)
- ✓Temporal link to active cannabis intoxication
- ✓Assessment of reality testing (patient awareness that experiences are drug-related)
- ✓Clear consciousness and orientation (distinguishing from delirium)
- ✓Note on whether these perceptual disturbances are a new or recurring pattern
Commonly Confused Codes
- •F12.220 — Cannabis dependence with intoxication, uncomplicated; use when no perceptual disturbances occur
- •F12.221 — Cannabis dependence with intoxication delirium; use when confusion and altered consciousness are present
- •F12.250-F12.251 — Cannabis dependence with psychotic disorder; use when psychosis persists beyond intoxication
- •F12.122 — Cannabis abuse with intoxication with perceptual disturbance; use when only abuse is documented