F10.131
BillableAlcohol abuse with withdrawal delirium
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F10.131 an HCC code?
Yes. F10.131 maps to Alcohol Use with Psychotic Complications under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Psychosis 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 F10.131
For F10.131 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 F10.131 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F10.131 is the ICD-10-CM diagnosis code for alcohol abuse with withdrawal delirium. Alcohol abuse with delirium that occurs during alcohol withdrawal, characterized by confusion, hallucinations, and autonomic instability. F10.131 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, F10.131 maps to Alcohol Use with Psychotic Complications (HCC 136) with a community, non-dual, aged base RAF weight of 0.275. Under the older CMS-HCC V24 model, F10.131 maps to Drug/Alcohol Psychosis (HCC 54) with a community, non-dual, aged base RAF weight of 0.434. 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 the timeline showing alcohol reduction or cessation followed by delirium symptoms. Because F10.131 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 F10.131 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
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
- •F10.2x — Alcohol dependence codes; dependence is a more severe pattern with tolerance/withdrawal/compulsive use — verify provider intent
- •F10.9x — Alcohol use, unspecified; less specific — always code to the highest documented specificity (abuse > unspecified)
- •F10.230-F10.239 — Alcohol dependence with withdrawal; withdrawal in an 'abuse' patient suggests possible dependence — query provider
- •F10.x30 — Withdrawal, uncomplicated; delirium represents a severe complication and should not be coded as uncomplicated withdrawal