What is ICD-10 code F13.921?

F13.921 is the ICD-10-CM diagnosis code for Sedative, hypnotic or anxiolytic use, unspecified with intoxication delirium. A person is using sedatives, sleeping pills, or anti-anxiety medications without a diagnosed dependence and is experiencing severe confusion and disorientation (delirium) from intoxication with these drugs. F13.921 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F13.921 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. F13.921 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. F13.921 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 F13.921 map to under V28?

F13.921 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 F13.921: Sedative, hypnotic

F13.921 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupF13.921

Effective 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)

F13.921

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

Sedative, hypnotic or anxiolytic use, unspecified with intoxication delirium

A person is using sedatives, sleeping pills, or anti-anxiety medications without a diagnosed dependence and is experiencing severe confusion and disorientation (delirium) from intoxication with these drugs.

Buddy Insight

Unspecified sedative use with intoxication delirium indicates a patient is experiencing acute confusion and disorientation from sedative intoxication.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

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

F13.9Sedative, hypnotic or anxiolytic-related use, unspecified F13.92Sedative, hypnotic or anxiolytic use, unspecified with intoxication F13.921Sedative, hypnotic or anxiolytic use, unspecified with intoxication delirium

Inclusion Terms

Official

Sedative, hypnotic, or anxiolytic-induced delirium

Excludes 2

Official

symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99

Related Codes

Official

F13.920Sedative, hypnotic or anxiolytic use, unspecified with intoxication, uncomplicated F13.929Sedative, hypnotic or anxiolytic use, unspecified with intoxication, unspecified

Includes

Official

disorders of psychological developmentInherited from F01-F99

Excludes 1

Official

sedative, hypnotic or anxiolytic-related abuse (F13.1-)Inherited from F13.9, F13.92
sedative, hypnotic or anxiolytic-related dependence (F13.2-)Inherited from F13.9, F13.92
sedative, hypnotic or anxiolytic use, unspecified with withdrawal (F13.93-)Inherited from F13.9, F13.92

Code First

Official

No Code First sequencing instructions are included in this display for F13.921. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F13.921. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F13.921. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Clinical findings of delirium: acute confusion, fluctuating consciousness, disorientation

Evidence of sedative intoxication (substance identified or clinical presentation consistent)

Temporal relationship between substance use and delirium onset

Mental status assessment documenting delirium features

MEAT Support

HCC Buddy guidance

Clinical findings of delirium: acute confusion, fluctuating consciousness, disorientation

Evidence of sedative intoxication (substance identified or clinical presentation consistent)

Temporal relationship between substance use and delirium onset

Mental status assessment documenting delirium features

Audit Caution

HCC Buddy guidance

Coding uncomplicated intoxication when delirium symptoms are clearly present

Confusing intoxication delirium with withdrawal delirium — the clinical context differs

Not recognizing delirium in a sedated patient who appears merely drowsy

Using unspecified use codes when the record supports abuse or dependence classification

Common Mistakes

HCC Buddy guidance

F13.920 — Unspecified use with intoxication uncomplicated; no delirium present

F13.121 — Sedative ABUSE with intoxication delirium; when abuse is confirmed

F13.221 — Sedative DEPENDENCE with intoxication delirium; when dependence is confirmed

F13.931 — Unspecified use with WITHDRAWAL delirium; delirium from withdrawal, not intoxication

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 F13.921 an HCC code?

Yes. F13.921 (Sedative, hypnotic or anxiolytic use, unspecified with intoxication delirium) 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: F13.921 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: F13.921
Description: Sedative, hypnotic or anxiolytic use, unspecified with intoxication delirium
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 F13.921 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F13.921

For F13.921, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

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What This Code Means

F13.921 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic use, unspecified with intoxication delirium. A person is using sedatives, sleeping pills, or anti-anxiety medications without a diagnosed dependence and is experiencing severe confusion and disorientation (delirium) from intoxication with these drugs. F13.921 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, F13.921 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 F13.921; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. 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.

This code indicates non-dependent use, so verify that dependence criteria are not met before assigning this code. For F13.921, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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 F13.921 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This code indicates non-dependent use, so verify that dependence criteria are not met before assigning this code
•Document the acute presentation of delirium and its temporal relationship to substance use

Clinical Significance

Unspecified sedative use with intoxication delirium indicates a patient is experiencing acute confusion and disorientation from sedative intoxication. The unspecified use status is common in emergency settings where substance use history is incomplete. The delirium component indicates a severe and potentially life-threatening presentation requiring immediate medical intervention regardless of the use pattern classification.

Documentation Requirements

✓Clinical findings of delirium: acute confusion, fluctuating consciousness, disorientation
✓Evidence of sedative intoxication (substance identified or clinical presentation consistent)
✓Temporal relationship between substance use and delirium onset
✓Mental status assessment documenting delirium features
✓Vital signs and monitoring data
✓Emergency interventions and treatment provided

Commonly Confused Codes

•F13.920: Unspecified use with intoxication uncomplicated; no delirium present
•F13.121: Sedative ABUSE with intoxication delirium; when abuse is confirmed
•F13.221: Sedative DEPENDENCE with intoxication delirium; when dependence is confirmed
•F13.931: Unspecified use with WITHDRAWAL delirium; delirium from withdrawal, not intoxication
•F05: Delirium due to physiological condition; not substance-induced