ICD-9 Code 291.0

Alcohol withdrawal delirium

Not Valid for Submission

291.0 is a legacy non-billable code used to specify a medical diagnosis of alcohol withdrawal delirium. This code was replaced on September 30, 2015 by its ICD-10 equivalent.

ICD-9: 291.0
Short Description:Delirium tremens
Long Description:Alcohol withdrawal delirium

Convert 291.0 to ICD-10

The following crosswalk between ICD-9 to ICD-10 is based based on the General Equivalence Mappings (GEMS) information:

  • F10.231 - Alcohol dependence with withdrawal delirium

Code Classification

  • Mental disorders (290–319)
    • Organic psychotic conditions (290-294)
      • 291 Alcoholic psychoses

Information for Medical Professionals

Index to Diseases and Injuries

References found for the code 291.0 in the Index of Diseases and Injuries:


Information for Patients


Alcohol Use Disorder (AUD)

What is alcohol use disorder (AUD)?

For most adults, moderate alcohol use is probably not harmful. However, about 18 million adult Americans have an alcohol use disorder (AUD). This means that their drinking causes distress and harm. AUD can range from mild to severe, depending on the symptoms. Severe AUD is sometimes called alcoholism or alcohol dependence.

AUD is a disease that causes:

  • Craving - a strong need to drink
  • Loss of control - not being able to stop drinking once you've started
  • Negative emotional state - feeling anxious and irritable when you are not drinking

What is binge drinking?

Binge drinking is drinking so much at once that your blood alcohol concentration (BAC) level is 0.08% or more. For a man, this usually happens after having 5 or more drinks within a few hours. For a woman, it is after about 4 or more drinks within a few hours. Not everyone who binge drinks has an AUD, but they are at higher risk for getting one.

What are the dangers of too much alcohol?

Too much alcohol is dangerous. Heavy drinking can increase the risk of certain cancers. It may lead to liver diseases, such as fatty liver disease and cirrhosis. It can also cause damage to the brain and other organs. Drinking during pregnancy can harm your baby. Alcohol also increases the risk of death from car crashes, injuries, homicide, and suicide.

How do I know if I have an alcohol use disorder (AUD)?

You may have an AUD if you can answer yes to two or more of these questions:

In the past year, have you:

  • Ended up drinking more or for a longer time than you had planned to?
  • Wanted to cut down or stop drinking, or tried to, but couldn't?
  • Spent a lot of your time drinking or recovering from drinking?
  • Felt a strong need to drink?
  • Found that drinking - or being sick from drinking - often interfered with your family life, job, or school?
  • Kept drinking even though it was causing trouble with your family or friends?
  • Given up or cut back on activities that you enjoyed just so you could drink?
  • Gotten into dangerous situations while drinking or after drinking? Some examples are driving drunk and having unsafe sex.
  • Kept drinking even though it was making you feel depressed or anxious? Or when it was adding to another health problem?
  • Had to drink more and more to feel the effects of the alcohol?
  • Had withdrawal symptoms when the alcohol was wearing off? They include trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, and sweating. In severe cases, you could have a fever, seizures, or hallucinations.

If you have any of these symptoms, your drinking may already be a cause for concern. The more symptoms you have, the more serious the problem is.

What should I do if I think that I might have an alcohol use disorder (AUD)?

If you think you might have an AUD, see your health care provider for an evaluation. Your provider can help make a treatment plan, prescribe medicines, and if needed, give you treatment referrals.

NIH: National Institute on Alcohol Abuse and Alcoholism


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Delirium

What is delirium?

Delirium is a mental state in which you are confused, disoriented, and not able to think or remember clearly. It usually starts suddenly. It is often temporary and treatable.

There are three types of delirium:

  • Hypoactive, where you are not active and seem sleepy, tired, or depressed
  • Hyperactive, where you are restless or agitated
  • Mixed, where you change back and forth between being hypoactive and hyperactive

What causes delirium?

There are many different problems that can cause delirium. Some of the more common causes include:

  • Alcohol or drugs, either from intoxication or withdrawal. This includes a serious type of alcohol withdrawal syndrome called delirium tremens. It usually happens to people who stop drinking after years of alcohol abuse.
  • Dehydration and electrolyte imbalances
  • Dementia
  • Hospitalization, especially in intensive care
  • Infections, such as urinary tract infections, pneumonia, and the flu
  • Medicines. This could be a side effect of a medicine, such as sedatives or opioids. Or it could be withdrawal after stopping a medicine.
  • Metabolic disorders
  • Organ failure, such as kidney or liver failure
  • Poisoning
  • Serious illnesses
  • Severe pain
  • Sleep deprivation
  • Surgeries, including reactions to anesthesia

Who is at risk for delirium?

Certain factors put you at risk for delirium, including:

  • Being in a hospital or nursing home
  • Dementia
  • Having a serious illness or more than one illness
  • Having an infection
  • Older age
  • Surgery
  • Taking medicines that affect the mind or behavior
  • Taking high doses of pain medicines, such as opioids

What are the symptoms of delirium?

The symptoms of delirium usually start suddenly, over a few hours or a few days. They often come and go. The most common symptoms include:

  • Changes in alertness (usually more alert in the morning, less at night)
  • Changing levels of consciousness
  • Confusion
  • Disorganized thinking, talking in a way that doesn't make sense
  • Disrupted sleep patterns, sleepiness
  • Emotional changes: anger, agitation, depression, irritability, overexcitement
  • Hallucinations and delusions
  • Incontinence
  • Memory problems, especially with short-term memory
  • Trouble concentrating

How is delirium diagnosed?

Your health care provider may use many tools to make a diagnosis:

  • A medical history, which includes asking about your symptoms
  • Physical and neurological exams
  • Mental status testing
  • Lab and diagnostic imaging tests

Delirium and dementia have similar symptoms, so it can be hard to tell them apart. They can also occur together. Delirium starts suddenly and can cause hallucinations. The symptoms may get better or worse and can last for hours or weeks. On the other hand, dementia develops slowly and does not cause hallucinations. The symptoms are stable and may last for months or years.

What are the treatments for delirium?

Treatment of delirium focuses on the causes and symptoms of delirium. The first step is to identify the cause. Often, treating the cause will lead to a full recovery. The recovery may take some time - weeks or sometimes even months. In the meantime, there may be treatments to manage the symptoms, such as:

  • Controlling the environment, which includes making sure that the room is quiet and well-lit, having clocks or calendars in view, and having family members around
  • Medicines, including those that control aggression or agitation and pain relievers if there is pain
  • If needed, making sure that the person has a hearing aid, glasses, or other devices for communication

Can delirium be prevented?

Treating the conditions that can cause delirium may reduce the risk of getting it. Hospitals can help lower the risk of delirium by avoiding sedatives and making sure that the room is kept quiet, calm, and well-lit. It can also help to have family members around and to have the same staff members treat the person.


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ICD-9 Footnotes

General Equivalence Map Definitions
The ICD-9 and ICD-10 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.

  • Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
  • No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
  • Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system.

Index of Diseases and Injuries Definitions

  • And - The word "and" should be interpreted to mean either "and" or "or" when it appears in a title.
  • Code also note - A "code also" note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction.
  • Code first - Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
  • Type 1 Excludes Notes - A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
  • Type 2 Excludes Notes - A type 2 Excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
  • Includes Notes - This note appears immediately under a three character code title to further define, or give examples of, the content of the category.
  • Inclusion terms - List of terms is included under some codes. These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
  • NEC "Not elsewhere classifiable" - This abbreviation in the Alphabetic Index represents "other specified". When a specific code is not available for a condition, the Alphabetic Index directs the coder to the "other specified” code in the Tabular List.
  • NOS "Not otherwise specified" - This abbreviation is the equivalent of unspecified.
  • See - The "see" instruction following a main term in the Alphabetic Index indicates that another term should be referenced. It is necessary to go to the main term referenced with the "see" note to locate the correct code.
  • See Also - A "see also" instruction following a main term in the Alphabetic Index instructs that there is another main term that may also be referenced that may provide additional Alphabetic Index entries that may be useful. It is not necessary to follow the "see also" note when the original main term provides the necessary code.
  • 7th Characters - Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters.
  • With - The word "with" should be interpreted to mean "associated with" or "due to" when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The word "with" in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order.