ICD-10 Coding for Severe Opioid Use Disorder(F11.20, Z79.891)
Complete ICD-10-CM coding and documentation guide for Severe Opioid Use Disorder. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Severe Opioid Use Disorder
F11.20-F11.29Primary Range
Opioid-related disorders
This range includes codes for opioid dependence and related complications, which are central to diagnosing severe opioid use disorder.
Long-term (current) use of opiate analgesic
This code is used for patients on long-term opioid therapy without a diagnosis of opioid use disorder.
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 the patient meets the criteria for severe opioid use disorder, with documented dependence. |
|
| Z79.891 | Long-term (current) use of opiate analgesic | Use for patients on long-term opioid therapy without a diagnosis of opioid use disorder. |
|
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 severe opioid use disorder
Essential facts and insights about Severe Opioid Use Disorder
Primary ICD-10-CM Codes for opioid use disorder severe
Decision Criteria
clinical Criteria
- Patient meets ≥6 DSM-5 criteria for opioid use disorder.
documentation Criteria
- Detailed documentation of opioid dependence and related impacts.
Applicable To
- Severe opioid use disorder meeting ≥6 DSM-5 criteria
Excludes
- Opioid abuse without dependence
- Long-term opioid use without dependence
Clinical Validation Requirements
- Documentation of ≥6 DSM-5 criteria
- Urine drug screen positive for non-prescribed opioids
Code-Specific Risks
- Misuse for patients on prescribed opioids without dependence
Coding Notes
- Ensure documentation specifies the number of DSM-5 criteria met.
Z79.891 - Long-term (current) use of opiate analgesic
Use for patients on long-term opioid therapy without a diagnosis of opioid use disorder.
Applicable To
- Chronic opioid therapy without dependence
Excludes
- Opioid dependence
- Opioid abuse
Clinical Validation Requirements
- Documentation of opioid use as prescribed without signs of dependence
Coding Notes
Do not use for patients with documented opioid dependence.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Opioid dependence with withdrawal
F11.23Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Severe Opioid Use Disorder to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F11.20.
Impact
Clinical: Inaccurate diagnosis and treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Use specific DSM-5 criteria in documentation, Provide detailed examples
Impact
Reimbursement: May lead to incorrect reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on the severity of opioid use disorder.
Mitigation Strategy
Query provider to specify severity and use F11.20 if ≥6 criteria are met.
Impact
Using F11.90 when severity is documented.
Mitigation Strategy
Ensure documentation specifies DSM-5 criteria met.
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 Severe Opioid Use Disorder, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Severe Opioid Use Disorder
Use these documentation templates to ensure complete and accurate documentation for Severe Opioid Use Disorder. These templates include all required elements for proper coding and billing.
Severe OUD with withdrawal symptoms
Specialty: Addiction MedicineRequired Elements
- DSM-5 criteria met
- Withdrawal symptoms
- Functional impairment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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