F13.131
BillableSedative, hypnotic or anxiolytic abuse with withdrawal delirium
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.131 an HCC code?
Yes. F13.131 maps to Drug/Alcohol Psychosis 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 F13.131
For F13.131 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 F13.131 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.131 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic abuse with withdrawal delirium. A person misuses sedatives, sleeping pills, or anti-anxiety medications and is experiencing withdrawal with severe confusion, disorientation, and altered consciousness (delirium). F13.131 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, F13.131 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F13.131 mapped to the same category but with a base RAF weight of 0.434 — V28 recalibrated weights across the entire model. 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.
Withdrawal delirium is a medical emergency requiring close monitoring and possible hospitalization. Because F13.131 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 F13.131 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Withdrawal delirium is a medical emergency requiring close monitoring and possible hospitalization
- •Document onset of delirium relative to last use and any autonomic symptoms (fever, tachycardia, hypertension)
Clinical Significance
Sedative, hypnotic, or anxiolytic abuse with withdrawal delirium is a medical emergency. Withdrawal delirium from sedatives (similar to delirium tremens from alcohol) involves severe confusion, autonomic instability, agitation, and can be fatal without treatment. This condition typically requires intensive care unit admission and aggressive pharmacological management. The code captures the highest level of withdrawal severity and maps to the highest substance use HCC category.
Documentation Requirements
- ✓Documentation of sedative/hypnotic/anxiolytic abuse
- ✓Acute delirium findings: severe confusion, disorientation, altered consciousness, agitation
- ✓Autonomic instability: fever, tachycardia, hypertension, diaphoresis
- ✓Temporal relationship to cessation or reduction of sedative use
- ✓Monitoring records (vital signs, neurological checks, sedation scales)
- ✓Treatment documentation (benzodiazepine taper, supportive care, ICU monitoring)
- ✓Exclusion of other causes of delirium
Commonly Confused Codes
- •F13.130 — Sedative abuse with withdrawal, uncomplicated; use when no delirium is present
- •F13.132 — Sedative abuse with withdrawal with perceptual disturbance; use when hallucinations occur without full delirium
- •F13.121 — Sedative abuse with intoxication delirium; different — this is intoxication-related, not withdrawal-related
- •F13.231 — Sedative dependence with withdrawal delirium; use when dependence is documented