F14.920
BillableCocaine use, unspecified with intoxication, uncomplicated
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F14.920 an HCC code?
Yes. F14.920 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 F14.920
For F14.920 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 F14.920 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F14.920 is the ICD-10-CM diagnosis code for cocaine use, unspecified with intoxication, uncomplicated. A person using cocaine who is experiencing intoxication without additional complications like confusion or hallucinations. F14.920 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, F14.920 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, F14.920 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.
This code represents uncomplicated intoxication; if delirium or perceptual disturbances are present, use more specific codes. Because F14.920 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 F14.920 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code represents uncomplicated intoxication; if delirium or perceptual disturbances are present, use more specific codes
- •Document the timing and amount of cocaine use to support the intoxication diagnosis
Clinical Significance
Cocaine use, unspecified with intoxication, uncomplicated is used when the provider documents cocaine intoxication but the clinical record does not establish whether the use pattern constitutes abuse or dependence. The 'unspecified' designation for the use pattern indicates a documentation gap regarding severity. Despite this, acute cocaine intoxication requires cardiovascular monitoring and behavioral assessment regardless of use pattern classification.
Documentation Requirements
- ✓Documentation of cocaine use (even without specifying abuse or dependence)
- ✓Clinical signs of active intoxication (euphoria, agitation, dilated pupils, tachycardia, hypertension)
- ✓Confirmation that intoxication is uncomplicated (no delirium or perceptual disturbance)
- ✓Vital signs documented during the intoxication
- ✓Assessment and monitoring plan