2025 ICD-10-CM code F11.1
Opioid abuse
Medical necessity for treatment is established by the presence of significant impairment in social, occupational, or other important areas of functioning due to opioid abuse.
Providers diagnose opioid abuse based on patient history, signs and symptoms, a detailed inquiry into personal and social behavior, and a physical examination. Laboratory studies may include blood tests for opioid levels. Treatment approaches include behavioral therapy, counseling, group therapy, residential treatment, and naloxone administration for overdose.
- Mental, Behavioral and Neurodevelopmental disorders (F01-F99)
- Mental and behavioral disorders due to psychoactive substance use (F10-F19)
In simple words: Opioid abuse is when someone uses opioids too much and it harms their health and life.It affects their work, school, family, and social interactions.They might be able to stop using for a while, but have trouble controlling their use once they start again.
Opioid abuse refers to a psychiatric condition in which excessive opioid consumption jeopardizes health and negatively affects work, school, family, and social life.
Example 1: A 25-year-old patient presents with lethargy, nausea, and constricted pupils. They admit to using heroin regularly despite negative consequences at work and home., A 40-year-old patient is brought to the ER after being found unresponsive.Blood tests reveal high levels of fentanyl.After being revived with naloxone, they admit to struggling with opioid abuse for years. , A patient with chronic pain due to a back injury is prescribed opioid pain medication. Over time, they begin taking more medication than prescribed and experience withdrawal symptoms when they try to reduce the dose.
Documentation should include type of opioid used, current severity of abuse, any complications (e.g., overdose, withdrawal), and remission status.
- Specialties:Addiction Medicine, Psychiatry, Internal Medicine, Family Medicine, Emergency Medicine
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office, Emergency Room - Hospital,Residential Substance Abuse Treatment Facility, Non-residential Substance Abuse Treatment Facility, Non-residential Opioid Treatment Facility, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home