F19.131
BillableOther psychoactive substance abuse with withdrawal delirium
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F19.131 an HCC code?
Yes. F19.131 maps to Drug Use with Psychotic Complications under the CMS-HCC V28 risk adjustment model (and Substance Use with Psychotic Complications 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 F19.131
For F19.131to 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 F19.131 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F19.131 is the ICD-10-CM diagnosis code for other psychoactive substance abuse with withdrawal delirium. A condition where someone abuses various drugs and experiences severe confusion and hallucinations when they stop using the substance. F19.131 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, F19.131 maps to Drug Use with Psychotic Complications (HCC 135) with a community, non-dual, aged base RAF weight of 0.424. Under the older CMS-HCC V24 model, F19.131 maps to Substance Use with Psychotic Complications (HCC 54) with a community, non-dual, aged base RAF weight of 0.329. 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 substance(s) involved when possible, as this may affect treatment planning. Because F19.131 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 F19.131 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific substance(s) involved when possible, as this may affect treatment planning
- •Ensure withdrawal delirium is clinically documented and distinguished from other withdrawal symptoms
Clinical Significance
This code captures withdrawal delirium from other psychoactive substance abuse, a medical emergency characterized by acute confusion, autonomic instability, and potential seizures. Withdrawal delirium requires intensive inpatient management with close hemodynamic monitoring and is associated with significant morbidity and mortality. Accurate coding is critical because this complication substantially increases resource utilization and expected healthcare costs.
Documentation Requirements
- ✓Provider documentation specifying the psychoactive substance(s) involved (e.g., designer drugs, bath salts, kratom, polysubstance use)
- ✓Clinical documentation supporting substance abuse pattern (maladaptive use pattern causing clinically significant impairment) without meeting criteria for dependence
- ✓Documentation of withdrawal symptoms temporally related to cessation or reduction of substance use
- ✓Clinical documentation of delirium during withdrawal: acute confusion, autonomic instability, agitation, hallucinations, and altered consciousness
- ✓Assessment and plan addressing the substance use disorder with treatment approach documented
Commonly Confused Codes
- •F19.20-F19.29 (Other psychoactive substance dependence) — dependence indicates a more severe pattern with tolerance, compulsive use, or withdrawal; abuse is a less severe use pattern
- •F19.90-F19.99 (Other psychoactive substance use, unspecified) — unspecified use is used when abuse vs. dependence is not documented
- •F19.130 (Withdrawal, uncomplicated) — uncomplicated withdrawal lacks the acute confusion and altered consciousness of delirium
- •F19.132 (Withdrawal with perceptual disturbance) — perceptual disturbance involves hallucinations without the global cognitive disruption of full delirium
- •F10-F16 (Specific substance codes: alcohol, opioids, cannabis, sedatives, cocaine, stimulants) — use substance-specific codes when the substance is identified; F19 is for 'other' or multiple unspecified substances