F13.232
BillableSedative, hypnotic or anxiolytic dependence 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 F13.232 an HCC code?
Yes. F13.232 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 F13.232
For F13.232 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 F13.232 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.232 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic dependence with withdrawal with perceptual disturbance. A person dependent on sedative, hypnotic, or anti-anxiety medications is experiencing withdrawal with perceptual disturbances such as hallucinations or illusions, but without full delirium. F13.232 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, F13.232 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F13.232 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 specific perceptual disturbances (visual, auditory, tactile hallucinations). Because F13.232 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 F13.232 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific perceptual disturbances (visual, auditory, tactile hallucinations)
- •Distinguish from F13.231 which includes delirium as a more severe complication
Clinical Significance
Withdrawal with perceptual disturbance represents a severe complication of sedative withdrawal where the patient experiences hallucinations or illusions while maintaining orientation, unlike full delirium. This is a warning sign of potential progression to delirium and requires close monitoring. The perceptual disturbances typically include visual or tactile hallucinations and indicate significant central nervous system irritability during withdrawal.
Documentation Requirements
- ✓Documentation of sedative, hypnotic, or anxiolytic dependence
- ✓Description of specific perceptual disturbances (visual, auditory, tactile hallucinations or illusions)
- ✓Clinical confirmation that full delirium criteria are NOT met (patient maintains basic orientation)
- ✓Timeline of substance cessation and onset of perceptual symptoms
- ✓Withdrawal severity scoring (CIWA-B or equivalent)
- ✓Monitoring plan and interventions for potential progression to delirium