ICD-10 Coding for Opiate Dependence(F11.20, F11.21)
Complete ICD-10-CM coding and documentation guide for Opiate Dependence. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Opiate Dependence
F11.1-F11.9Primary Range
Mental and behavioral disorders due to use of opioids
This range covers all ICD-10 codes related to opioid use disorders, including dependence, abuse, and use.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| F11.20 | Opioid dependence, uncomplicated | Use when a patient meets criteria for opioid dependence without complications. |
|
| F11.21 | Opioid dependence, in remission | Use when a patient is in remission from opioid dependence. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for opiate dependence
Essential facts and insights about Opiate Dependence
Primary ICD-10-CM Codes for opiate dependence
Decision Criteria
clinical Criteria
- Patient meets DSM-5 criteria for opioid use disorder.
Applicable To
- Opioid dependence without complications
Clinical Validation Requirements
- Documented DSM-5 criteria for opioid use disorder
- Positive urine drug screen for opioids
Code-Specific Risks
- Incorrectly coding for abuse or use when dependence criteria are met
Coding Notes
- Ensure documentation supports the diagnosis of dependence, not just use or abuse.
F11.21 - Opioid dependence, in remission
Use when a patient is in remission from opioid dependence.
Applicable To
- Opioid dependence in sustained remission
Excludes
- Active opioid dependence (F11.20)
Clinical Validation Requirements
- Explicit documentation of remission status
- No current opioid use
Coding Notes
Ensure remission is clearly documented in the patient's record.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long-term (current) use of opiate analgesic
Z79.891Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Opiate Dependence to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F11.20.
Impact
Clinical: Inadequate treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Use specific terms like 'opioid dependence'., Document DSM-5 criteria.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records and statistics.
Mitigation Strategy
Use F11.21 with documentation of remission status.
Impact
Failure to document remission can lead to audit issues.
Mitigation Strategy
Ensure clear documentation of remission status.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Opiate Dependence, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Opiate Dependence
Use these documentation templates to ensure complete and accurate documentation for Opiate Dependence. These templates include all required elements for proper coding and billing.
MAT Clinic Visit
Specialty: Addiction MedicineRequired Elements
- Patient history
- DSM-5 criteria
- Current use status
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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