F13.231

HCC Category Mapping

What This Code Means

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.

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

Commonly Confused Codes