F15.221
BillableOther stimulant dependence with intoxication delirium
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F15.221 an HCC code?
Yes. F15.221 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 F15.221
For F15.221to 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 F15.221 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F15.221 is the ICD-10-CM diagnosis code for other stimulant dependence with intoxication delirium. A person dependent on stimulants who is intoxicated and experiencing delirium, which is severe confusion and disorientation caused by the drug. F15.221 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, F15.221 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, F15.221 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 presence of delirium symptoms such as confusion, disorientation, or altered consciousness during intoxication. Because F15.221 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 F15.221 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document presence of delirium symptoms such as confusion, disorientation, or altered consciousness during intoxication
- •This is more severe than uncomplicated intoxication and requires specific clinical documentation
Clinical Significance
Stimulant dependence with intoxication delirium is a medical emergency indicating severe neuropsychiatric toxicity from stimulant use in a dependent patient. Delirium during stimulant intoxication can present with extreme agitation, hyperthermia, rhabdomyolysis, and cardiovascular collapse. This high-acuity presentation requires intensive medical management and carries significant morbidity and mortality risk.
Documentation Requirements
- ✓Documented stimulant dependence
- ✓Clinical evidence of acute intoxication
- ✓Specific documentation of delirium: acute onset confusion, altered consciousness, disorientation, fluctuating mental status
- ✓Vital signs and laboratory findings supporting the diagnosis (elevated temperature, tachycardia, elevated CK)
- ✓Level of care required and any emergent interventions performed
Commonly Confused Codes
- •F15.220 — Stimulant dependence with uncomplicated intoxication; use when delirium is absent
- •F15.222 — Stimulant dependence with intoxication with perceptual disturbance; perceptual changes without true delirium
- •F05 — Delirium due to known physiological condition; use for non-substance-induced delirium
- •F15.121 — Stimulant abuse with intoxication delirium; requires abuse rather than dependence documentation