F14.121
BillableCocaine abuse with intoxication with delirium
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F14.121 an HCC code?
Yes. F14.121 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 F14.121
For F14.121 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 F14.121 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F14.121 is the ICD-10-CM diagnosis code for cocaine abuse with intoxication with delirium. A person abuses cocaine and is currently intoxicated, experiencing confusion and disorientation (delirium) as a result. F14.121 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, F14.121 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, F14.121 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 indicates acute mental status changes; document the specific symptoms observed during the intoxication episode. Because F14.121 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 F14.121 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Delirium indicates acute mental status changes; document the specific symptoms observed during the intoxication episode
- •This code requires documentation of both active cocaine abuse and current intoxication with delirium
Clinical Significance
Cocaine abuse with intoxication delirium is a medical emergency featuring acute confusion, agitation, and disorientation from cocaine intoxication. Cocaine-induced delirium can present with extreme agitation, hyperthermia, and rhabdomyolysis, and carries a risk of sudden cardiac death. This condition often requires emergency department care with aggressive medical management and cardiovascular monitoring.
Documentation Requirements
- ✓Documentation of cocaine abuse pattern
- ✓Clinical findings of delirium: acute confusion, disorientation, agitation, fluctuating consciousness
- ✓Temporal relationship between cocaine use and delirium onset
- ✓Vital signs including temperature (hyperthermia common)
- ✓Cardiac monitoring and lab results (troponin, CPK for rhabdomyolysis)
- ✓Emergency interventions and treatment provided
- ✓Assessment for excited delirium syndrome