F13.231
BillableSedative, hypnotic or anxiolytic dependence with withdrawal delirium
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.231 an HCC code?
Yes. F13.231 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 F13.231
For F13.231 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 F13.231 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.231 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic dependence with withdrawal delirium. A person dependent on sedative, hypnotic, or anti-anxiety medications is experiencing withdrawal with delirium, a serious condition involving confusion, disorientation, and hallucinations during the withdrawal process. F13.231 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, F13.231 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F13.231 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.
Document the onset and progression of delirium symptoms during withdrawal. Because F13.231 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 F13.231 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the onset and progression of delirium symptoms during withdrawal
- •This is a medical emergency requiring close monitoring and possible hospitalization
Clinical Significance
Sedative withdrawal delirium is a life-threatening medical emergency requiring immediate intervention, often in an intensive care setting. Unlike alcohol withdrawal delirium (delirium tremens), benzodiazepine withdrawal delirium can be prolonged and carries a high mortality risk without treatment. The psychotic features of this withdrawal elevate it to the highest substance use HCC category. This is one of the most clinically severe substance use presentations.
Documentation Requirements
- ✓Documentation of sedative, hypnotic, or anxiolytic dependence
- ✓Clinical findings of delirium: acute onset, fluctuating consciousness, disorientation, agitation
- ✓Temporal relationship between substance cessation/reduction and delirium onset
- ✓Vital signs including temperature, heart rate, blood pressure (autonomic instability is common)
- ✓Glasgow Coma Scale or CAM-ICU assessment
- ✓Treatment plan including medication management and level of care