F13.221
BillableSedative, hypnotic or anxiolytic dependence with intoxication delirium
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.221 an HCC code?
Yes. F13.221 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 F13.221
For F13.221 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 F13.221 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.221 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic dependence with intoxication delirium. A person dependent on sedative, hypnotic, or anti-anxiety medications is experiencing intoxication with delirium, a serious condition involving confusion, disorientation, and altered mental status. F13.221 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, F13.221 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, F13.221 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.
Document specific delirious symptoms such as hallucinations, agitation, or disorientation. Because F13.221 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 F13.221 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document specific delirious symptoms such as hallucinations, agitation, or disorientation
- •This is a more severe presentation than uncomplicated intoxication and may require emergency intervention
Clinical Significance
Sedative dependence with intoxication delirium is a medical emergency characterized by acute confusion, disorientation, and potential agitation in a dependent patient who is intoxicated. This condition can be life-threatening and often requires hospitalization. The delirium component significantly increases clinical severity and resource utilization compared to uncomplicated intoxication.
Documentation Requirements
- ✓Documentation of sedative, hypnotic, or anxiolytic dependence
- ✓Clinical findings consistent with delirium: acute onset confusion, fluctuating consciousness, disorientation
- ✓Temporal relationship between substance intoxication and delirium onset
- ✓Glasgow Coma Scale or other mental status assessment documenting delirium severity
- ✓Vital signs and monitoring parameters
- ✓Emergency interventions and treatment provided