F13.139
BillableSedative, hypnotic or anxiolytic abuse with withdrawal, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.139 an HCC code?
Yes. F13.139 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Dependence 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 F13.139
For F13.139 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 F13.139 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.139 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic abuse with withdrawal, unspecified. Misuse of sedatives, sleeping pills, or anti-anxiety medications with withdrawal symptoms, but the specific withdrawal symptoms are not detailed. F13.139 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, F13.139 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe (HCC 137) with a community, non-dual, aged base RAF weight of 0.358. Under the older CMS-HCC V24 model, F13.139 maps to Drug/Alcohol Dependence (HCC 55) with a community, non-dual, aged base RAF weight of 0.334. 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.
Use this code when withdrawal is documented but lacks specificity; consider querying for more detailed withdrawal symptoms. Because F13.139 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 F13.139 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when withdrawal is documented but lacks specificity; consider querying for more detailed withdrawal symptoms
- •This is a less specific code; if withdrawal details are available, use more specific F13.13x codes
Clinical Significance
Sedative, hypnotic, or anxiolytic abuse with unspecified withdrawal is used when withdrawal from these substances is documented but the specific features are not detailed. Given the potential life-threatening nature of sedative withdrawal (seizures, delirium), this documentation gap is clinically concerning. Providers should be queried about the presence of delirium, perceptual disturbances, or seizures to assign a more specific and clinically appropriate code.
Documentation Requirements
- ✓Documentation of sedative/hypnotic/anxiolytic abuse
- ✓Evidence of withdrawal symptoms
- ✓Basic clinical findings supporting withdrawal
- ✓Documentation of why more specific withdrawal details could not be determined
Commonly Confused Codes
- •F13.130 — Sedative abuse with withdrawal, uncomplicated; use when documentation confirms uncomplicated withdrawal
- •F13.131 — Sedative abuse with withdrawal delirium; use when delirium is present
- •F13.132 — Sedative abuse with withdrawal with perceptual disturbance; use when hallucinations occur
- •F13.10 — Sedative abuse, uncomplicated; use when no withdrawal is present