2025 ICD-10-CM code F11.9
Opioid use, unspecified. This code excludes opioid abuse (F11.1-) and opioid dependence (F11.2-).
Medical necessity for the treatment of opioid use is established by the documented presence of signs, symptoms, and behaviors indicative of problematic use, impacting the patient's physical, mental, and/or social well-being.
Providers diagnose opioid use based on the patient’s history, signs and symptoms, a detailed inquiry into personal and social behavior, and physical examination. Laboratory studies, such as blood tests for opioid levels, may also be used. Treatment approaches include behavioral therapy, medications to help reduce the desire to use opioids, and naloxone to block the drug's effect in case of intoxication. Medication-assisted treatment (MAT) is the primary treatment, and involves medication, patient counseling, and support from family and friends.
- Mental, Behavioral and Neurodevelopmental disorders (F01-F99)
- Mental and behavioral disorders due to psychoactive substance use (F10-F19)
In simple words: This code describes a situation where someone is using opioids excessively, but the specific type of opioid or the severity of the problem isn't clear.It's important to note that this code doesn't apply if the person is addicted to or abusing opioids – there are different codes for those situations.
Unspecified opioid use refers to excessive consumption of opioids where the type or degree of use is not documented by the provider.This subcategory specifically excludes opioid abuse and dependence.Opioids are substances that produce the same effects as opiates (drugs made from the opium poppy) and are used for pain relief and sedation. They can be natural (e.g., morphine) or synthetic (e.g., codeine, heroin, fentanyl).In healthcare, opioid analgesics are used for severe pain management.Opioid use can lead to tolerance, withdrawal symptoms, and difficulty discontinuing use despite negative impacts on personal and social life.Symptoms of opioid use can include nausea, vomiting, delirium, lethargy, decreased immunity, and excessive somnolence. Diagnosis is based on patient history, signs and symptoms, inquiry into personal and social behavior, physical examination, and laboratory tests (e.g., blood tests for opioid levels).Treatment approaches include behavioral therapy, medications to reduce opioid cravings, and naloxone administration for opioid intoxication. Medication-assisted treatment (MAT) is the primary treatment, combining medication, counseling, and support.
Example 1: A patient presents with symptoms suggestive of opioid use, such as lethargy and nausea, but denies abuse or dependence and the specific opioid used is unknown. F11.9 is used., A patient is found unresponsive with signs of opioid overdose, but no further information about their opioid use history is available at the time of admission. F11.9 is initially used., During a routine check-up, a patient admits to using opioids recreationally but does not meet the criteria for abuse or dependence, and the type of opioid is not specified. F11.9 may be used.
Documentation should include the patient's history, signs and symptoms, details of personal and social behavior related to opioid use, results of physical examinations, and laboratory findings.If the type of opioid, severity of use, presence of complications, or remission status are known, they should also be documented.
- Specialties:Addiction Medicine, Internal Medicine, Family Medicine, Emergency Medicine, Psychiatry, Pain Management
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office, Emergency Room - Hospital, Telehealth Provided in Patient’s Home,Telehealth Provided Other than in Patient’s Home, Residential Substance Abuse Treatment Facility, Non-residential Substance Abuse Treatment Facility, Non-residential Opioid Treatment Facility