F14.281
BillableCocaine dependence with cocaine-induced sexual dysfunction
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F14.281 an HCC code?
Yes. F14.281 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).
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 F14.281
For F14.281to 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 F14.281 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F14.281 is the ICD-10-CM diagnosis code for cocaine dependence with cocaine-induced sexual dysfunction. A person is dependent on cocaine and has developed sexual dysfunction (difficulty with sexual performance or desire) caused by the cocaine use. F14.281 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, F14.281 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, F14.281 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.
Document the specific type of sexual dysfunction if available (erectile dysfunction, decreased libido, etc.). Because F14.281 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 F14.281 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific type of sexual dysfunction if available (erectile dysfunction, decreased libido, etc.)
- •This code indicates the dysfunction is directly related to cocaine dependence and use
Clinical Significance
Cocaine dependence with cocaine-induced sexual dysfunction captures the impact of chronic cocaine dependence on sexual health. Long-term cocaine use disrupts dopamine pathways essential for sexual arousal and function, and cocaine's vasoconstrictive effects can contribute to erectile dysfunction. In dependent patients, sexual dysfunction is often more persistent than in those with abuse patterns, reflecting chronic neuroadaptive changes. This condition affects quality of life and may influence treatment motivation and adherence.
Documentation Requirements
- ✓Provider documentation of cocaine dependence
- ✓Specific type of sexual dysfunction documented (erectile dysfunction, decreased libido, anorgasmia, delayed ejaculation)
- ✓Causal relationship between cocaine dependence and sexual dysfunction established
- ✓Documentation ruling out other medical causes (diabetes mellitus, hypertension, medication effects)
- ✓Timeline showing sexual dysfunction relative to cocaine use history
- ✓Impact on relationships and quality of life
Commonly Confused Codes
- •F14.181 — Cocaine abuse with cocaine-induced sexual dysfunction: use when the pattern is abuse
- •N52.9 — Male erectile dysfunction, unspecified: use when not related to cocaine
- •F52.0 — Hypoactive sexual desire disorder: use when not substance-induced
- •F14.288 — Cocaine dependence with other cocaine-induced disorder: use for other induced conditions
- •F14.981 — Cocaine use, unspecified with cocaine-induced sexual dysfunction: use when abuse vs. dependence is unclear