ICD-10 Coding for Opioid Use Disorder(F11.10, F11.20)
Complete ICD-10-CM coding and documentation guide for 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 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 |
|---|---|---|---|
| F11.10 | Opioid abuse, uncomplicated | Use when there is documented opioid abuse without signs of dependence. |
|
| F11.20 | Opioid dependence, uncomplicated | Use when there is evidence of 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 opioid use disorder
Essential facts and insights about Opioid Use Disorder
Primary ICD-10-CM Codes for opioid use disorder
Decision Criteria
clinical Criteria
- Patient uses opioids without meeting dependence criteria.
Applicable To
- Opioid abuse without dependence
Excludes
- Opioid dependence (F11.20)
Clinical Validation Requirements
- Patient reports using opioids beyond prescribed dose without tolerance or withdrawal symptoms.
Code-Specific Risks
- Misclassification if dependence is present.
Coding Notes
- Ensure DSM-5 criteria for abuse are met before coding.
F11.20 - Opioid dependence, uncomplicated
Use when there is evidence of opioid dependence.
Applicable To
- Opioid addiction
Excludes
- Opioid abuse (F11.10)
Clinical Validation Requirements
- Documented tolerance, withdrawal, or compulsive use.
Coding Notes
Dependence takes precedence over abuse.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Opioid Use Disorder to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F11.10.
Impact
Clinical: May lead to misdiagnosis., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Use checklists for DSM-5 criteria., Regular training on documentation standards.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate representation of patient condition.
Mitigation Strategy
Use Z79.891 for prescribed use without disorder.
Impact
Inaccurate coding of opioid overdoses can lead to audits.
Mitigation Strategy
Ensure T40 codes are used with F11 codes for overdoses.
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 Use Disorder, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Opioid Use Disorder
Use these documentation templates to ensure complete and accurate documentation for Opioid Use Disorder. These templates include all required elements for proper coding and billing.
Emergency Department Visit for Opioid Overdose
Specialty: Emergency MedicineRequired Elements
- Patient presentation and symptoms
- UDS results
- History of opioid use
- DSM-5 criteria met
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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