F14.221

Billable

Cocaine dependence with intoxication delirium

HCC Category Mapping

V28HCC 137 — Drug Use Disorder/Substance Use Disorder, Moderate/Severe

0.358

V24HCC 55 — Drug/Alcohol Dependence

0.334

ESRDHCC 55 — Drug/Alcohol Dependence

0.000

What This Code Means

A person who is dependent on cocaine and is currently intoxicated, experiencing confusion and disorientation (delirium) as a result of the intoxication.

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

Code Hierarchy

└F14.221Cocaine dependence with intoxication delirium