What is ICD-10 code F14.121?

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. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F14.121 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F14.121 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. F14.121 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. F14.121 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.

What is the V28 vs V24 difference for F14.121?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For F14.121, V28 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications at RAF 0.424 while V24 mapped to Substance Use Disorder, Moderate/Severe, or Substance Use with Complications at RAF 0.329. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting F14.121?

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 Because F14.121 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM F14.121: Cocaine abuse

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Code lookupF14.121Effective 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)

F14.121

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

Cocaine abuse with intoxication with delirium

A person abuses cocaine and is currently intoxicated, experiencing confusion and disorientation (delirium) as a result.

Buddy Insight

Cocaine abuse with intoxication delirium is a medical emergency featuring acute confusion, agitation, and disorientation from cocaine intoxication.

CMS-HCC V28

Mapped

HCC 137

Drug Use Disorder, Moderate/S...

RAF 0.424

CMS-HCC V24

Mapped

HCC 55

Substance Use Disorder, Moder...

RAF 0.329

ACA/HHS

Mapped

HCC 82

HHS-HCC 82

Varies by metal level

ESRD/PACE

Mapped

HCC 55

Substance Use Disorder, Moder...

RAF 0.111

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F14.1Cocaine abuse

F14.12Cocaine abuse with intoxication

F14.121Cocaine abuse with intoxication with delirium

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F14.121 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F14.121 in this effective period.

Related Child Codes

Official

F14.120Cocaine abuse with intoxication, uncomplicated

F14.122Cocaine abuse with intoxication with perceptual disturbance

F14.129Cocaine abuse with intoxication, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for F14.121 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F14.121 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F14.121 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F14.121 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F14.121 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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)

MEAT Support

HCC Buddy guidance

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)

Audit Caution

HCC Buddy guidance

Coding uncomplicated intoxication when delirium criteria are clearly met

Not recognizing excited delirium as a medical emergency requiring immediate intervention

Confusing intoxication-related agitation with delirium — delirium requires disorientation and fluctuating consciousness

Assigning dependence codes when only abuse is documented

Common Mistakes

HCC Buddy guidance

F14.120 — Cocaine abuse with intoxication uncomplicated; no delirium present

F14.122 — Cocaine abuse with intoxication perceptual disturbance; hallucinations without full delirium

F14.221 — Cocaine DEPENDENCE with intoxication delirium; when dependence is confirmed

F14.150 — Cocaine abuse with psychotic disorder with delusions; psychotic disorder during use, not acute delirium

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 F14.121 an HCC code?

Yes. F14.121 (Cocaine abuse with intoxication with delirium) maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications under the CMS-HCC V28 risk adjustment model (and Substance Use Disorder, Moderate/Severe, or Substance Use with Complications under V24), with a community non-dual aged RAF of 0.424. It is billable for payment year 2026.

Coder answer: F14.121 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: F14.121
Description: Cocaine abuse with intoxication with delirium
HCC (V28): HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
RAF: 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

V24HCC 55, Substance Use Disorder, Moderate/Severe, or Substance Use with Complications

0.329

ESRDHCC 55, Substance Use Disorder, Moderate/Severe, or Substance Use with Complications

0.111

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work F14.121 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

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.

Coder workflow notes

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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, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a community, non-dual, aged base RAF weight of 0.424. Under the older CMS-HCC V24 model, F14.121 maps to Substance Use Disorder, Moderate/Severe, or Substance Use with Complications (HCC 55) with a community, non-dual, aged base RAF weight of 0.329. 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

Commonly Confused Codes

•F14.120: Cocaine abuse with intoxication uncomplicated; no delirium present
•F14.122: Cocaine abuse with intoxication perceptual disturbance; hallucinations without full delirium
•F14.221: Cocaine DEPENDENCE with intoxication delirium; when dependence is confirmed
•F14.150: Cocaine abuse with psychotic disorder with delusions; psychotic disorder during use, not acute delirium
•F15.121: Other STIMULANT abuse with intoxication delirium; wrong substance category