F13.229
BillableSedative, hypnotic or anxiolytic dependence with intoxication, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.229 an HCC code?
Yes. F13.229 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 F13.229
For F13.229 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 F13.229 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.229 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic dependence with intoxication, unspecified. A person dependent on sedative, hypnotic, or anti-anxiety medications is experiencing intoxication, but the specific details or severity of the intoxication are not documented. F13.229 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, F13.229 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, F13.229 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.
Use this code only when intoxication is present but cannot be classified as uncomplicated or with delirium. Because F13.229 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 F13.229 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 cannot be classified as uncomplicated or with delirium
- •Request clarification from the provider about the nature and severity of intoxication symptoms
Clinical Significance
This code indicates sedative dependence with intoxication where the severity or complications of the intoxication are not specified. It represents a documentation gap where the provider has identified both dependence and intoxication but has not clarified whether delirium or other complications are present. This is an opportunity for clinical documentation improvement.
Documentation Requirements
- ✓Documentation of sedative, hypnotic, or anxiolytic dependence
- ✓Evidence of current intoxication from the substance
- ✓Clinical note explaining why the intoxication severity could not be specified
- ✓Vital signs and basic assessment during the intoxication episode
- ✓Substance type and any available details about the intoxication presentation