F14.921 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software

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Code lookupF14.921

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)

F14.921

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Cocaine use, unspecified with intoxication delirium

A person using cocaine who is experiencing intoxication with delirium, characterized by confusion and altered mental status.

Buddy Insight

Cocaine use, unspecified with intoxication delirium captures a medical emergency where a patient using cocaine develops acute delirium during intoxication, but the use pattern (abuse vs.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 137

Drug Use Disorder, Moderate/S...

Coefficient HCC 137: 0.424 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 082

HHS-HCC 082 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 55

Substance Use Disorder/Modera...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F14.9Cocaine use, unspecified F14.92Cocaine use, unspecified with intoxication F14.921Cocaine use, unspecified with intoxication delirium

Inclusion Terms

Official

No inclusion terms are included in this display for F14.921. Check the code and parent instructions in the Code Book.

Excludes 2

Official

symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99, F14
other stimulant-related disorders (F15.-)Inherited from F01-F99, F14

Related Codes

Official

F14.920Cocaine use, unspecified with intoxication, uncomplicated F14.922Cocaine use, unspecified with intoxication with perceptual disturbance F14.929Cocaine use, unspecified with intoxication, unspecified

Includes

Official

disorders of psychological developmentInherited from F01-F99

Excludes 1

Official

cocaine abuse (F14.1-)Inherited from F14.9
cocaine dependence (F14.2-)Inherited from F14.9

Code First

Official

No Code First sequencing instructions are included in this display for F14.921. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F14.921. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F14.921. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of cocaine use (use pattern may be unspecified)

Documentation of acute delirium with specific symptoms (confusion, disorientation, altered consciousness)

Temporal relationship between cocaine use and delirium onset

Vital signs including temperature documentation

MEAT Support

HCC Buddy guidance

Documentation of cocaine use (use pattern may be unspecified)

Documentation of acute delirium with specific symptoms (confusion, disorientation, altered consciousness)

Temporal relationship between cocaine use and delirium onset

Vital signs including temperature documentation

Audit Caution

HCC Buddy guidance

Not querying the provider about abuse vs. dependence status when clinically feasible

Confusing delirium with psychosis — delirium involves altered consciousness while psychosis involves organized delusions/hallucinations

Using a general delirium code instead of this substance-specific code

Coding delirium without documenting the specific features that distinguish it from uncomplicated intoxication

Common Mistakes

HCC Buddy guidance

F14.121 — Cocaine abuse with intoxication delirium: use when abuse is established

F14.221 — Cocaine dependence with intoxication delirium: use when dependence is established

F14.920 — Cocaine use, unspecified with intoxication, uncomplicated: use when delirium is NOT present

F14.922 — Cocaine use, unspecified with intoxication with perceptual disturbance: use when perceptual disturbances occur without full delirium

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is F14.921 an HCC code?

Yes. F14.921 (Cocaine use, unspecified with intoxication delirium) maps to HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.424. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: F14.921 is billable and maps to V28 HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F14.921
Description: Cocaine use, unspecified with intoxication delirium
HCC (V28): HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
RAF reference coefficient: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications

0.424

ESRDHCC 55, Substance Use Disorder/Moderate/Severe/Substance Use with Complications

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work F14.921 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F14.921

For F14.921, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

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What This Code Means

F14.921 is the ICD-10-CM diagnosis code for cocaine use, unspecified with intoxication delirium. A person using cocaine who is experiencing intoxication with delirium, characterized by confusion and altered mental status. F14.921 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, F14.921 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a source-labeled community, non-dual, aged reference coefficient of 0.424. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Delirium must be documented as a direct result of cocaine intoxication. For F14.921, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for F14.921 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 a direct result of cocaine intoxication
•Distinguish from other causes of delirium; ensure cocaine use is temporally related to symptom onset

Clinical Significance

Cocaine use, unspecified with intoxication delirium captures a medical emergency where a patient using cocaine develops acute delirium during intoxication, but the use pattern (abuse vs. dependence) has not been determined. Cocaine intoxication delirium involves acute confusion, disorientation, psychomotor agitation, and autonomic instability. This can represent excited delirium syndrome, which carries significant mortality risk from cardiac arrest, hyperthermia, and rhabdomyolysis, requiring emergency medical intervention.

Documentation Requirements

✓Documentation of cocaine use (use pattern may be unspecified)
✓Documentation of acute delirium with specific symptoms (confusion, disorientation, altered consciousness)
✓Temporal relationship between cocaine use and delirium onset
✓Vital signs including temperature documentation
✓Medical workup ruling out other causes of delirium
✓Level of care provided (emergency department, intensive care unit)
✓Mental status examination

Commonly Confused Codes

•F14.121: Cocaine abuse with intoxication delirium: use when abuse is established
•F14.221: Cocaine dependence with intoxication delirium: use when dependence is established
•F14.920: Cocaine use, unspecified with intoxication, uncomplicated: use when delirium is NOT present
•F14.922: Cocaine use, unspecified with intoxication with perceptual disturbance: use when perceptual disturbances occur without full delirium
•F05: Delirium due to known physiological condition: use when delirium is caused by a medical condition, not cocaine