F13.132
BillableSedative, hypnotic or anxiolytic abuse with withdrawal with perceptual disturbance
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.132 an HCC code?
Yes. F13.132 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 F13.132
For F13.132 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 F13.132 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.132 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic abuse with withdrawal with perceptual disturbance. A person misuses sedatives, sleeping pills, or anti-anxiety medications and is experiencing withdrawal with hallucinations, delusions, or other perceptual disturbances while maintaining clear consciousness. F13.132 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, F13.132 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F13.132 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.
Perceptual disturbance indicates hallucinations or delusions without the confusion of delirium. Because F13.132 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 F13.132 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Perceptual disturbance indicates hallucinations or delusions without the confusion of delirium
- •Distinguish from F13.131 (delirium) by noting that consciousness and orientation are relatively preserved
Clinical Significance
Sedative, hypnotic, or anxiolytic abuse with withdrawal with perceptual disturbance represents a serious withdrawal complication where the patient experiences hallucinations or illusions while maintaining relatively clear consciousness. This distinguishes from withdrawal delirium where consciousness is impaired. Perceptual disturbances during sedative withdrawal indicate significant central nervous system excitability and risk for progression to withdrawal seizures or delirium.
Documentation Requirements
- ✓Documentation of sedative/hypnotic/anxiolytic abuse
- ✓Description of perceptual disturbances (visual, auditory, or tactile hallucinations; illusions)
- ✓Confirmation that consciousness and orientation are relatively preserved (distinguishing from delirium)
- ✓Temporal relationship to cessation or reduction of sedative use
- ✓Exclusion of other causes of hallucinations
- ✓Monitoring for progression to withdrawal delirium or seizures