2025 ICD-10-CM code F11
Opioid-related disorders encompass a range of conditions stemming from opioid use, including abuse, dependence, and other opioid-induced disorders.
Medical necessity must be established for any services related to opioid use disorder. This entails demonstrating that the patient's condition significantly impairs their functioning and requires medical intervention. The documentation must support the diagnosis and the need for the specific treatment provided.
- Mental, Behavioral and Neurodevelopmental disorders (F01-F99)
- Mental and behavioral disorders due to psychoactive substance use (F10-F19)
In simple words: This code refers to problems related to opioid use, including addiction, difficulty quitting, and other problems caused by opioid use.
This code encompasses conditions related to the use of opioids, including but not limited to abuse, dependence, intoxication, withdrawal, and other mental or behavioral disorders induced by opioid use.It includes cases where the individual's opioid use has caused clinically significant impairment or distress, manifesting in various ways like strong cravings, unsuccessful attempts to reduce use, neglecting major roles due to opioid use, and continuing use despite negative consequences.
Example 1: A 25-year-old patient presents with a history of using prescription painkillers for recreational purposes. They admit to experiencing withdrawal symptoms when they try to stop and are unable to control their use despite negative consequences at work and in their relationships. This would be coded as F11.10 (Opioid abuse, uncomplicated)., A 40-year-old individual is brought to the emergency room experiencing an opioid overdose. They exhibit signs of opioid intoxication, including slowed breathing and pinpoint pupils. Upon further examination, they also demonstrate perceptual disturbances, such as hallucinations. This scenario points to F11.122 (Opioid abuse with intoxication with perceptual disturbance)., A 30-year-old patient with a long history of opioid dependence is admitted to a rehabilitation facility. They experience significant withdrawal symptoms, including anxiety, nausea, and insomnia. They also exhibit signs of an opioid-induced psychotic disorder with delusions. This situation would be coded as F11.150 (Opioid abuse with opioid-induced psychotic disorder with delusions).
Documentation should include the type of opioid used, the frequency and amount of use, the presence of withdrawal symptoms or tolerance, the impact of opioid use on the patient's daily life (social, occupational, interpersonal), and any related physical or mental health conditions.Detailed clinical findings supporting the diagnosis are crucial, such as evidence from urine drug screens, behavioral observations, and patient self-reporting.The documentation needs to be comprehensive and justify the assigned code.
- Specialties:Addiction medicine, psychiatry, pain management, internal medicine, emergency medicine, family medicine.
- Place of Service:Inpatient Hospital, Residential Substance Abuse Treatment Facility, Outpatient Hospital, Office, Emergency Room - Hospital, Telehealth Provided in Patient's Home,Telehealth Provided Other than in Patient’s Home.