ICD-10 Coding for Opioid Withdrawal(F11.93, F11.23)
Complete ICD-10-CM coding and documentation guide for Opioid Withdrawal. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Opioid Withdrawal
F11.9-F11.99Primary Range
Mental and behavioral disorders due to use of opioids
This range includes codes for opioid use disorders and withdrawal symptoms.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| F11.93 | Opioid withdrawal without use disorder | Use when a patient experiences withdrawal symptoms without meeting criteria for opioid use disorder. |
|
| F11.23 | Opioid withdrawal with moderate or severe use disorder | Use when a patient meets criteria for moderate or severe opioid use disorder and is experiencing withdrawal. |
|
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 withdrawal
Essential facts and insights about Opioid Withdrawal
Primary ICD-10-CM Codes for opioid withdrawal
Decision Criteria
clinical Criteria
- COWS score and absence of opioid use disorder
documentation Criteria
- Explicit statement of no opioid use disorder
Applicable To
- Opioid withdrawal without a diagnosis of opioid use disorder
Clinical Validation Requirements
- COWS score ≥5
- Documented absence of opioid use disorder
Code-Specific Risks
- Incorrectly coding when opioid use disorder is present.
Coding Notes
- Ensure documentation clearly states the absence of opioid use disorder.
F11.23 - Opioid withdrawal with moderate or severe use disorder
Use when a patient meets criteria for moderate or severe opioid use disorder and is experiencing withdrawal.
Applicable To
- Opioid withdrawal with moderate or severe opioid use disorder
Excludes
- Opioid withdrawal without use disorder (F11.93)
Clinical Validation Requirements
- DSM-5 criteria for moderate/severe opioid use disorder
- COWS score indicating withdrawal
Coding Notes
Ensure documentation includes DSM-5 criteria for opioid use disorder.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Opioid withdrawal with moderate or severe use disorder
F11.23Opioid withdrawal with mild use disorder
F11.13Opioid withdrawal without use disorder
F11.93Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Opioid Withdrawal to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F11.93.
Impact
Clinical: Inadequate clinical validation of withdrawal., Regulatory: Potential audit issues., Financial: Risk of denied claims.
Mitigation Strategy
Ensure COWS score is documented for all withdrawal cases.
Impact
Reimbursement: May lead to incorrect DRG assignment and reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Verify the presence of opioid use disorder and use F11.23 or F11.13 as appropriate.
Impact
Risk of incorrect coding without proper documentation.
Mitigation Strategy
Ensure comprehensive documentation of symptoms and use disorder 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 Opioid Withdrawal, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Opioid Withdrawal
Use these documentation templates to ensure complete and accurate documentation for Opioid Withdrawal. These templates include all required elements for proper coding and billing.
Emergency Department Presentation
Specialty: Emergency MedicineRequired Elements
- Last opioid use
- COWS score
- Withdrawal symptoms
- Opioid use disorder status
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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