ICD-10 Coding for Opioid Addiction(F11.10, F11.20, F11.9)
Complete ICD-10-CM coding and documentation guide for Opioid Addiction. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Opioid Addiction
F11.1-F11.9Primary Range
Mental and behavioral disorders due to use of opioids
This range includes codes for opioid use, abuse, and dependence, which are central to diagnosing opioid addiction.
Long term (current) use of opiate analgesic
Used to indicate long-term opioid therapy, often in conjunction with opioid use disorder codes.
Poisoning by, adverse effect of and underdosing of synthetic narcotics
Relevant for cases involving opioid overdose or adverse effects.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| F11.10 | Opioid abuse, uncomplicated | Use when there is documented opioid abuse without dependence. |
|
| F11.20 | Opioid dependence, uncomplicated | Use when there is documented opioid dependence. |
|
| F11.9 | Opioid use, unspecified | Use when opioid use is documented but does not meet criteria for abuse or 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 opioid addiction
Essential facts and insights about Opioid Addiction
Primary ICD-10-CM Codes for opioid addiction
Decision Criteria
clinical Criteria
- Presence of social or legal issues due to opioid use
Applicable To
- Opioid abuse NOS
Excludes
- Opioid dependence (F11.20)
Clinical Validation Requirements
- Documented social or legal problems due to opioid use
Code-Specific Risks
- Misclassification if dependence criteria are met
Coding Notes
- Ensure documentation specifies abuse without dependence.
F11.20 - Opioid dependence, uncomplicated
Use when there is documented opioid dependence.
Applicable To
- Opioid addiction
Excludes
- Opioid abuse (F11.10)
Clinical Validation Requirements
- Documented tolerance or withdrawal symptoms
Coding Notes
Document all DSM-5 criteria met for dependence.
F11.9 - Opioid use, unspecified
Use when opioid use is documented but does not meet criteria for abuse or dependence.
Applicable To
- Opioid use NOS
Excludes
- Opioid abuse (F11.10)
- Opioid dependence (F11.20)
Clinical Validation Requirements
- Documented opioid use without meeting criteria for abuse or dependence
Coding Notes
Ensure documentation clearly states opioid use without abuse or dependence.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long term (current) use of opiate analgesic
Z79.891Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Opioid Addiction to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F11.10.
Impact
Clinical: Leads to inaccurate diagnosis and treatment., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials or audits.
Mitigation Strategy
Train staff on DSM-5 criteria., Use checklists for documentation.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Misclassification may result in compliance issues., Data Quality: Affects the accuracy of patient records.
Mitigation Strategy
Verify DSM-5 criteria for dependence before coding.
Impact
Reimbursement: Vague documentation can lead to claim rejections., Compliance: Non-specific documentation may not meet audit standards., Data Quality: Reduces the specificity and usefulness of health data.
Mitigation Strategy
Specify the type of disorder: use, abuse, or dependence.
Impact
High risk of audits due to frequent misclassification.
Mitigation Strategy
Ensure thorough documentation of DSM-5 criteria and treatment plans.
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 Opioid Addiction, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Opioid Addiction
Use these documentation templates to ensure complete and accurate documentation for Opioid Addiction. These templates include all required elements for proper coding and billing.
Opioid dependence with withdrawal symptoms
Specialty: Addiction MedicineRequired Elements
- Patient history
- DSM-5 criteria
- Withdrawal symptoms
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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