F19.231
BillableOther psychoactive substance dependence with withdrawal delirium
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F19.231 an HCC code?
Yes. F19.231 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 F19.231
For F19.231 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 F19.231 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F19.231 is the ICD-10-CM diagnosis code for other psychoactive substance dependence with withdrawal delirium. A person who is dependent on psychoactive substances and is experiencing withdrawal with severe confusion and disorientation (delirium). F19.231 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, F19.231 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F19.231 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 delirium symptoms and their relationship to substance withdrawal. Because F19.231 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 F19.231 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document delirium symptoms and their relationship to substance withdrawal
- •Note vital signs and any medical complications accompanying withdrawal delirium
Clinical Significance
This code captures withdrawal delirium from other psychoactive substance dependence, 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 dependence criteria: tolerance, withdrawal symptoms, compulsive use despite harm, or inability to control use
- ✓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