What is ICD-10 code F19.931?

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. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F19.931 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F19.931 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F19.931 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F19.931 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for F19.931?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For F19.931, V28 maps to Drug/Alcohol Psychosis at RAF 0.000 while V24 mapped to Drug/Alcohol Psychosis at RAF 0.434. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting F19.931?

This is a more severe withdrawal presentation with delirium requiring medical intervention Withdrawal delirium is a medical emergency requiring close monitoring and treatment Because F19.931 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

F19.931 ICD-10 Code: Other psychoactive substance

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupF19.931Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)

F19.931

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Other psychoactive substance use, unspecified with withdrawal delirium

Stopping use of various psychoactive substances with withdrawal symptoms including confusion, disorientation, or altered mental state.

Buddy Insight

Other psychoactive substance use, unspecified with withdrawal delirium is a medical emergency representing the most dangerous form of substance withdrawal.

CMS-HCC V28

Mapped

HCC 135

Drug/Alcohol Psychosis

RAF 0.0

CMS-HCC V24

Mapped

HCC 54

Drug/Alcohol Psychosis

RAF 0.434

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 54

Drug/Alcohol Psychosis

RAF 0.0

RXHCC

Not risk-adjusted for this model/period.

RAF 0

Code Trumping

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Code Book Path

Official

F19.9Other psychoactive substance use, unspecified

F19.93Other psychoactive substance use, unspecified with withdrawal

F19.931Other psychoactive substance use, unspecified with withdrawal delirium

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F19.931 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F19.931 in this effective period.

Related Child Codes

Official

F19.930Other psychoactive substance use, unspecified with withdrawal, uncomplicated

F19.932Other psychoactive substance use, unspecified with withdrawal with perceptual disturbance

F19.939Other psychoactive substance use, unspecified with withdrawal, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for F19.931 in this effective period.

Excludes 1

Official

other psychoactive substance use, unspecified with intoxication (F19.92-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F19.931 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F19.931 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F19.931 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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)

MEAT Support

HCC Buddy guidance

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)

Audit Caution

HCC Buddy guidance

Coding uncomplicated withdrawal (F19.930) when documentation clearly describes delirium features during withdrawal

Confusing withdrawal delirium with intoxication delirium — the clinical context (cessation vs. active use) is key

Missing the higher HCC value: F19.931 maps to HCC 54 (Drug/Alcohol Psychosis) rather than HCC 55, representing a significant difference in RAF weight

Using non-specific delirium codes when the etiology is clearly substance withdrawal

Common Mistakes

HCC Buddy guidance

F19.930 — UNCOMPLICATED withdrawal lacks delirium; ensure full delirium criteria are met before coding F19.931

F19.921 — INTOXICATION with delirium is a different clinical scenario (active substance effects vs. withdrawal)

F10.231 — ALCOHOL withdrawal delirium (delirium tremens) should be used when the substance is specifically alcohol

F19.932 — Withdrawal with PERCEPTUAL DISTURBANCE is less severe than withdrawal delirium

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

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

V28HCC 135, Drug/Alcohol Psychosis

0.000

V24HCC 54, Drug/Alcohol Psychosis

0.434

ESRDHCC 54, Drug/Alcohol Psychosis

0.000

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 F19.931to 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)

Commonly Confused Codes

•F19.930 — UNCOMPLICATED withdrawal lacks delirium; ensure full delirium criteria are met before coding F19.931
•F19.921 — INTOXICATION with delirium is a different clinical scenario (active substance effects vs. withdrawal)
•F10.231 — ALCOHOL withdrawal delirium (delirium tremens) should be used when the substance is specifically alcohol
•F19.932 — Withdrawal with PERCEPTUAL DISTURBANCE is less severe than withdrawal delirium
•F05 — Delirium due to known physiological condition should be used when delirium is from a medical cause, not withdrawal