F16.921
BillableHallucinogen use, unspecified with intoxication with delirium
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F16.921 an HCC code?
Yes. F16.921 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 F16.921
For F16.921 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 F16.921 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F16.921 is the ICD-10-CM diagnosis code for hallucinogen use, unspecified with intoxication with delirium. A person uses hallucinogenic drugs and experiences severe confusion and disorientation (delirium) from the intoxication. F16.921 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, F16.921 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, F16.921 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.
Delirium is a serious acute mental state requiring immediate clinical attention and documentation. Because F16.921 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 F16.921 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Delirium is a serious acute mental state requiring immediate clinical attention and documentation
- •Document the specific symptoms of delirium such as confusion, disorientation, and altered consciousness
Clinical Significance
Hallucinogen use with intoxication delirium represents an acute psychiatric emergency where the patient has altered consciousness, confusion, and disorientation from hallucinogen intoxication. This code captures the severity of the acute presentation and justifies emergency-level care regardless of whether the use pattern meets abuse or dependence criteria.
Documentation Requirements
- ✓Documentation of hallucinogen use (pattern unspecified)
- ✓Clinical evidence of delirium: acute confusion, disorientation, fluctuating consciousness
- ✓Temporal link to hallucinogen use
- ✓Mental status examination documenting delirium findings
- ✓Medical workup excluding other delirium etiologies
- ✓Monitoring and treatment plan for acute delirium