F19.931
BillableOther psychoactive substance 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 F19.931 an HCC code?
Yes. F19.931 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 F19.931
For F19.931 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 F19.931 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F19.931 is the ICD-10-CM diagnosis code for other psychoactive substance use, unspecified with withdrawal delirium. Stopping use of various psychoactive substances with withdrawal symptoms including confusion, disorientation, or altered mental state. F19.931 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, F19.931 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F19.931 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.
This is a more severe withdrawal presentation with delirium requiring medical intervention. Because F19.931 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 F19.931 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a more severe withdrawal presentation with delirium requiring medical intervention
- •Withdrawal delirium is a medical emergency requiring close monitoring and treatment
Clinical Significance
Other psychoactive substance use, unspecified with withdrawal delirium is a medical emergency representing the most dangerous form of substance withdrawal. Withdrawal delirium (delirium tremens in alcohol, though this code covers other substances) can be life-threatening and requires intensive medical intervention, often in an ICU setting. This code captures the acute severity and high resource utilization of this critical presentation, making it essential for accurate risk adjustment.
Documentation Requirements
- ✓Documentation of active withdrawal from psychoactive substance(s)
- ✓Clinical assessment confirming delirium criteria (acute onset, fluctuating consciousness, disorientation, cognitive disturbance)
- ✓Vital signs monitoring documentation (tachycardia, hypertension, fever are common)
- ✓Use of validated delirium assessment tool (CAM, CAM-ICU)
- ✓Description of severity, including any autonomic instability or seizure risk
- ✓Intensive monitoring and treatment plan (benzodiazepines, IV fluids, seizure precautions)