F10.931
BillableAlcohol use, unspecified with withdrawal delirium
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F10.931 an HCC code?
Yes. F10.931 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 F10.931
For F10.931 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 F10.931 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F10.931 is the ICD-10-CM diagnosis code for alcohol use, unspecified with withdrawal delirium. A person uses alcohol and is experiencing withdrawal with delirium, causing severe confusion and altered mental status. F10.931 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, F10.931 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, F10.931 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.
Delirium tremens is a medical emergency requiring immediate intervention. Because F10.931 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 F10.931 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Delirium tremens is a medical emergency requiring immediate intervention
- •Document the presence of delirium specifically; this is a more severe form of withdrawal than uncomplicated
Clinical Significance
This code captures alcohol unspecified use 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 alcohol use — query the provider to specify abuse or dependence for more accurate coding when possible
- ✓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.)