F14.13
BillableCocaine abuse, unspecified with withdrawal
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F14.13 an HCC code?
Yes. F14.13 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 F14.13
For F14.13 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 F14.13 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F14.13 is the ICD-10-CM diagnosis code for cocaine abuse, unspecified with withdrawal. A person abuses cocaine and is experiencing withdrawal symptoms after stopping or reducing cocaine use. F14.13 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, F14.13 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, F14.13 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 withdrawal symptoms (depression, fatigue, anhedonia, etc.) as cocaine withdrawal can present with various symptoms. Because F14.13 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 F14.13 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document specific withdrawal symptoms (depression, fatigue, anhedonia, etc.) as cocaine withdrawal can present with various symptoms
- •Withdrawal indicates the person has stopped using cocaine; if they are still actively using, this code would not apply
Clinical Significance
Cocaine abuse with withdrawal captures a critical clinical state where the patient has reduced or stopped cocaine use and is experiencing withdrawal symptoms such as severe depression, fatigue, anhedonia, increased appetite, and psychomotor retardation. This diagnosis is significant because cocaine withdrawal, while not typically life-threatening like alcohol or benzodiazepine withdrawal, carries substantial suicide risk due to the profound dysphoria. It also indicates the patient's use pattern is severe enough to produce physiological adaptation.
Documentation Requirements
- ✓Provider must document cocaine as the specific substance of abuse
- ✓Abuse pattern (not dependence) must be established per DSM-5 criteria
- ✓Documentation of recent cessation or significant reduction in cocaine use
- ✓Specific withdrawal symptoms must be described (e.g., dysphoria, fatigue, vivid unpleasant dreams, insomnia or hypersomnia, increased appetite, psychomotor retardation or agitation)
- ✓Temporal relationship between stopping cocaine and symptom onset
- ✓Assessment of suicide risk given the depression associated with cocaine withdrawal
Commonly Confused Codes
- •F14.23 — Cocaine dependence with withdrawal: use when the substance use pattern meets dependence rather than abuse criteria
- •F14.14 — Cocaine abuse with cocaine-induced mood disorder: use when the mood disturbance is the primary induced condition rather than a general withdrawal state
- •F14.120 — Cocaine abuse with intoxication, uncomplicated: opposite clinical scenario; intoxication is active use, withdrawal is after cessation
- •F14.10 — Cocaine abuse, uncomplicated: use when no intoxication, withdrawal, or induced disorders are present