F13.931

HCC Category Mapping

What This Code Means

A person is experiencing delirium (confusion, disorientation, hallucinations) as a result of withdrawing from sedative, hypnotic, or anti-anxiety medications.

Coding Tips

• •Delirium is a medical emergency; ensure appropriate severity coding and concurrent medical management documentation
• •Document the timeline of last substance use and onset of delirium symptoms to support withdrawal diagnosis

Clinical Significance

Withdrawal delirium from sedative use is a medical emergency with significant mortality risk. The unspecified use pattern is secondary to the immediate clinical urgency of managing delirium tremens-like symptoms including severe agitation, autonomic instability, seizures, and psychosis. This condition typically requires ICU-level care. The psychotic features elevate this to the highest substance use HCC category.

Documentation Requirements

• ✓Clinical findings of delirium during sedative withdrawal: confusion, agitation, disorientation, autonomic instability
• ✓Timeline of substance cessation and delirium onset
• ✓Vital signs including temperature, heart rate, blood pressure (autonomic instability markers)
• ✓CAM-ICU or other delirium assessment tool results
• ✓Level of care documentation (ICU, monitored bed)
• ✓Medication management for withdrawal delirium (benzodiazepine taper, phenobarbital, etc.)

Commonly Confused Codes