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2025 ICD-10-CM code F11.2

Opioid dependence.

Use F11.2 for dependence on opioids, excluding opioid abuse (F11.1-) and opioid use, unspecified (F11.9-). Also, exclude opioid poisoning (T40.0-T40.2-).

Medical necessity for treatment of opioid dependence is established by the presence of significant impairment or distress related to opioid use, impacting the individual's physical or mental health and daily functioning. Justification often involves documentation of failed attempts to reduce or stop opioid use, presence of withdrawal symptoms, negative consequences related to opioid use, and a treatment plan aimed at improving the individual's overall well-being.

Diagnosis of opioid dependence involves a comprehensive assessment of the patient's history, signs, symptoms, personal and social behavior, and a physical examination. Laboratory tests, including blood tests for opioid levels, may also be conducted. Treatment approaches include behavioral therapy, counseling, group therapy, medication (such as naloxone for overdose), and residential rehabilitation programs.

In simple words: Opioid dependence means that a person has trouble stopping their opioid use, even when they want to. They need more of the drug to get the same effect and feel sick when they try to stop. This can cause problems in their daily life.

Opioid dependence refers to a problematic pattern of opioid use that leads to significant impairment or distress. Individuals with opioid dependence experience a range of physical and psychological symptoms, including tolerance, withdrawal, and cravings, alongside behavioral changes that affect their daily lives.

Example 1: A 30-year-old patient presents with a history of increasing opioid use for chronic back pain, now experiencing withdrawal symptoms when attempting to reduce the dosage. They report strong cravings and neglecting social responsibilities due to drug seeking. This scenario aligns with opioid dependence., A 45-year-old individual with a long history of heroin use enters a detoxification program, demonstrating classic withdrawal symptoms like sweating, chills, and muscle aches. They express a desire to quit but struggle with intense cravings. This case represents opioid dependence., A 25-year-old patient initially prescribed opioids after a car accident exhibits escalating drug-seeking behavior, obtaining prescriptions from multiple doctors. Despite facing relationship issues and job loss due to their opioid use, they continue to take the drug. This aligns with the criteria of opioid dependence.

Documentation for F11.2 should include the type of opioid used, the severity of dependence, any complications (e.g., withdrawal symptoms, overdose events), and the patient's remission status.

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