F10.131

HCC Category Mapping

What This Code Means

Alcohol abuse with delirium that occurs during alcohol withdrawal, characterized by confusion, hallucinations, and autonomic instability.

Coding Tips

• •Document the timeline showing alcohol reduction or cessation followed by delirium symptoms
• •This is a medical emergency requiring careful monitoring and treatment

Clinical Significance

This code captures alcohol abuse with withdrawal delirium (delirium tremens), indicating physiological dependence severe enough to produce withdrawal symptoms upon cessation or reduction of alcohol intake. Withdrawal delirium (delirium tremens) is a life-threatening medical emergency with mortality rates of 1-5% even with treatment, requiring intensive monitoring. Withdrawal codes carry significant risk adjustment implications and reflect high-acuity clinical scenarios.

Documentation Requirements

• ✓Documentation of a maladaptive pattern of alcohol use with clinically significant impairment or distress (recurrent use causing role failure, hazardous use, legal problems, or social/interpersonal problems)
• ✓Confirmation that criteria for alcohol dependence are NOT met (no tolerance, withdrawal, or compulsive use pattern)
• ✓Documentation of withdrawal symptoms (tremor, diaphoresis, tachycardia, hypertension, anxiety, nausea, seizures) occurring after reduction or cessation of alcohol use
• ✓Documentation of delirium tremens: severe confusion, agitation, hallucinations, autonomic instability, fever — a medical emergency requiring ICU-level care
• ✓Assessment and plan addressing alcohol use disorder with treatment recommendations (counseling, medication-assisted treatment, referral, etc.)

Commonly Confused Codes