F14.221
BillableCocaine dependence with intoxication delirium
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F14.221 an HCC code?
Yes. F14.221 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 F14.221
For F14.221 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 F14.221 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F14.221 is the ICD-10-CM diagnosis code for cocaine dependence with intoxication delirium. A person who is dependent on cocaine and is currently intoxicated, experiencing confusion and disorientation (delirium) as a result of the intoxication. F14.221 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, F14.221 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, F14.221 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 must be documented as present; this is more severe than uncomplicated intoxication. Because F14.221 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 F14.221 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Delirium must be documented as present; this is more severe than uncomplicated intoxication
- •Verify that delirium is acute and related to current cocaine intoxication
Clinical Significance
Cocaine dependence with intoxication delirium represents a medical emergency where a cocaine-dependent patient develops acute confusion, disorientation, and altered consciousness during cocaine intoxication. Cocaine-induced delirium can manifest with agitation, combativeness, autonomic instability, and hyperthermia (excited delirium syndrome), which carries significant mortality risk. This condition often requires emergency department management, sedation protocols, and intensive monitoring for rhabdomyolysis, cardiac arrhythmias, and multi-organ failure.
Documentation Requirements
- ✓Provider documentation of cocaine dependence
- ✓Documentation of acute delirium with specific symptoms (confusion, disorientation, altered consciousness, agitation)
- ✓Temporal relationship between cocaine use and delirium onset
- ✓Documentation establishing the delirium is due to cocaine intoxication (not other medical causes)
- ✓Vital signs including temperature (hyperthermia assessment)
- ✓Mental status examination documenting altered sensorium
- ✓Medical workup ruling out other causes of delirium (infection, metabolic, head trauma)
- ✓Level of care and monitoring provided
Commonly Confused Codes
- •F14.220 — Cocaine dependence with intoxication, uncomplicated: use when intoxication is present WITHOUT delirium
- •F14.222 — Cocaine dependence with intoxication with perceptual disturbance: use when perceptual disturbances are present but full delirium is NOT
- •F14.121 — Cocaine abuse with intoxication delirium: use when the pattern is abuse rather than dependence
- •F05 — Delirium due to known physiological condition: use when delirium is caused by a medical condition, not substance intoxication
- •F14.250 — Cocaine dependence with cocaine-induced psychotic disorder with delusions: use when persistent psychosis is present rather than acute intoxication delirium