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Resource Opioid

Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01 – F99)

b. Mental and behavioral disorders due to psychoactive substance use

3. Psychoactive Substance Use, Unspecified
As with all other unspecified diagnoses, the codes for unspecified psychoactive substance use (F10.9-, F11.9-, F12.9-, F13.9-, F14.9-, F15.9-, F16.9-, F18.9-, F19.9-) should only be assigned based on provider documentation and when they meet the definition of a reportable diagnosis (see Section III, Reporting Additional Diagnoses). These codes are to be used only when the psychoactive substance use is associated with a physical disorder included in chapter 5 (such as sexual dysfunction and sleep disorder), or a mental or behavioral disorder, and such a relationship is documented by the provider.

  • A code of F11.20, opioid dependence, should not be assigned for patients taking pain medication as prescribed.
  • Instead a code of Z79.891, long term use of opiates, should be assigned.
Opioid Use Disorders
(HCC 54/55)
F11.1_* ‐ Opioid abuse
F11.2_* ‐ Opioid dependence
F11.9_* ‐ Opioid use
Subcategories include:
*._0 – Uncomplicated
*._1 – In remission
*._2 – with intoxication∞
*._3 – with withdrawal
*._4 – with induced mood disorder
*._5 – psychoƟc disorders∞
*._8 – other induced disorders∞
*._9 – unspecified induced
disorder
∞sixth character is required

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• Medicare Claims Processing Manual (Pub.100-04), Chapter 24
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c24.pdf
• Medicare Claims Processing Manual (Pub. 100-04), Chapter 25
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c25.pdf
• Medicare Claims Processing Manual, (Pub. 100-04) Chapter 26
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c26.pdf
• Medicare Claims Processing Manual, (Pub. 100-04) Chapter 39
https://www.cms.gov/files/document/chapter-39-opioid-treatment-programs-otps.pdf

• Opioid Treatment Programs (OTP) webpage
https://www.cms.gov/Center/Provider-Type/Opioid-Treatment-Program-Center

ICD-10 CodeICD-10 Description
F11Opioid related disorders
F11.1Opioid abuse
F11.10Opioid abuse, uncomplicated
F11.11Opioid abuse, in remission
F11.12Opioid abuse with intoxication
F11.120Opioid abuse with intoxication, uncomplicated
F11.121Opioid abuse with intoxication delirium
F11.122Opioid abuse with intoxication with perceptual disturbance
F11.129Opioid abuse with intoxication, unspecified
F11.13Opioid abuse with withdrawal
F11.14Opioid abuse with opioid-induced mood disorder
F11.15Opioid abuse with opioid-induced psychotic disorder
F11.150Opioid abuse with opioid-induced psychotic disorder with delusions
F11.151Opioid abuse with opioid-induced psychotic disorder with hallucinations
F11.159Opioid abuse with opioid-induced psychotic disorder, unspecified
F11.18Opioid abuse with other opioid-induced disorder
F11.181Opioid abuse with opioid-induced sexual dysfunction
F11.182Opioid abuse with opioid-induced sleep disorder
F11.188Opioid abuse with other opioid-induced disorder
F11.19Opioid abuse with unspecified opioid-induced disorder
F11.2Opioid dependence
F11.20Opioid dependence, uncomplicated
F11.21Opioid dependence, in remission
F11.22Opioid dependence with intoxication
F11.220Opioid dependence with intoxication, uncomplicated
F11.221Opioid dependence with intoxication delirium
F11.222Opioid dependence with intoxication with perceptual disturbance
F11.229Opioid dependence with intoxication, unspecified
F11.23Opioid dependence with withdrawal
F11.24Opioid dependence with opioid-induced mood disorder
F11.25Opioid dependence with opioid-induced psychotic disorder
F11.250Opioid dependence with opioid-induced psychotic disorder with delusions
F11.251Opioid dependence with opioid-induced psychotic disorder with hallucinations
F11.259Opioid dependence with opioid-induced psychotic disorder, unspecified
F11.28Opioid dependence with other opioid-induced disorder
F11.281Opioid dependence with opioid-induced sexual dysfunction
F11.282Opioid dependence with opioid-induced sleep disorder
F11.288Opioid dependence with other opioid-induced disorder
F11.29Opioid dependence with unspecified opioid-induced disorder
F11.9Opioid use, unspecified
F11.92Opioid use, unspecified with intoxication
F11.920Opioid use, unspecified with intoxication, uncomplicated
F11.921Opioid use, unspecified with intoxication delirium
F11.922Opioid use, unspecified with intoxication with perceptual disturbance
F11.929Opioid use, unspecified with intoxication, unspecified
F11.93Opioid use, unspecified with withdrawal
F11.94Opioid use, unspecified with opioid-induced mood disorder
F11.95Opioid use, unspecified with opioid-induced psychotic disorder
F11.950Opioid use, unspecified with opioid-induced psychotic disorder with delusions
F11.951Opioid use, unspecified with opioid-induced psychotic disorder with hallucinations
F11.959Opioid use, unspecified with opioid-induced psychotic disorder, unspecified
F11.98Opioid use, unspecified with other specified opioid-induced disorder
F11.981Opioid use, unspecified with opioid-induced sexual dysfunction
F11.982Opioid use, unspecified with opioid-induced sleep disorder
F11.988Opioid use, unspecified with other opioid-induced disorder
F11.99Opioid use, unspecified with unspecified opioid-induced disorder
 

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