F13.931
BillableSedative, hypnotic or anxiolytic use, unspecified with withdrawal delirium
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.931 an HCC code?
Yes. F13.931 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 F13.931
For F13.931 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 F13.931 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.931 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic use, unspecified with withdrawal delirium. A person is experiencing delirium (confusion, disorientation, hallucinations) as a result of withdrawing from sedative, hypnotic, or anti-anxiety medications. F13.931 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, F13.931 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F13.931 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.
Delirium is a medical emergency; ensure appropriate severity coding and concurrent medical management documentation. Because F13.931 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 F13.931 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
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.)