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.
(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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mraalert.blogspot.com
• 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
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.
(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
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-...
www.cco.community
Opioid Use Disorder
Stay up to date with the most current information in healthcare.
mraalert.blogspot.com
• 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 Code | ICD-10 Description |
|---|---|
| F11 | Opioid related disorders |
| F11.1 | Opioid abuse |
| F11.10 | Opioid abuse, uncomplicated |
| F11.11 | Opioid abuse, in remission |
| F11.12 | Opioid abuse with intoxication |
| F11.120 | Opioid abuse with intoxication, uncomplicated |
| F11.121 | Opioid abuse with intoxication delirium |
| F11.122 | Opioid abuse with intoxication with perceptual disturbance |
| F11.129 | Opioid abuse with intoxication, unspecified |
| F11.13 | Opioid abuse with withdrawal |
| F11.14 | Opioid abuse with opioid-induced mood disorder |
| F11.15 | Opioid abuse with opioid-induced psychotic disorder |
| F11.150 | Opioid abuse with opioid-induced psychotic disorder with delusions |
| F11.151 | Opioid abuse with opioid-induced psychotic disorder with hallucinations |
| F11.159 | Opioid abuse with opioid-induced psychotic disorder, unspecified |
| F11.18 | Opioid abuse with other opioid-induced disorder |
| F11.181 | Opioid abuse with opioid-induced sexual dysfunction |
| F11.182 | Opioid abuse with opioid-induced sleep disorder |
| F11.188 | Opioid abuse with other opioid-induced disorder |
| F11.19 | Opioid abuse with unspecified opioid-induced disorder |
| F11.2 | Opioid dependence |
| F11.20 | Opioid dependence, uncomplicated |
| F11.21 | Opioid dependence, in remission |
| F11.22 | Opioid dependence with intoxication |
| F11.220 | Opioid dependence with intoxication, uncomplicated |
| F11.221 | Opioid dependence with intoxication delirium |
| F11.222 | Opioid dependence with intoxication with perceptual disturbance |
| F11.229 | Opioid dependence with intoxication, unspecified |
| F11.23 | Opioid dependence with withdrawal |
| F11.24 | Opioid dependence with opioid-induced mood disorder |
| F11.25 | Opioid dependence with opioid-induced psychotic disorder |
| F11.250 | Opioid dependence with opioid-induced psychotic disorder with delusions |
| F11.251 | Opioid dependence with opioid-induced psychotic disorder with hallucinations |
| F11.259 | Opioid dependence with opioid-induced psychotic disorder, unspecified |
| F11.28 | Opioid dependence with other opioid-induced disorder |
| F11.281 | Opioid dependence with opioid-induced sexual dysfunction |
| F11.282 | Opioid dependence with opioid-induced sleep disorder |
| F11.288 | Opioid dependence with other opioid-induced disorder |
| F11.29 | Opioid dependence with unspecified opioid-induced disorder |
| F11.9 | Opioid use, unspecified |
| F11.92 | Opioid use, unspecified with intoxication |
| F11.920 | Opioid use, unspecified with intoxication, uncomplicated |
| F11.921 | Opioid use, unspecified with intoxication delirium |
| F11.922 | Opioid use, unspecified with intoxication with perceptual disturbance |
| F11.929 | Opioid use, unspecified with intoxication, unspecified |
| F11.93 | Opioid use, unspecified with withdrawal |
| F11.94 | Opioid use, unspecified with opioid-induced mood disorder |
| F11.95 | Opioid use, unspecified with opioid-induced psychotic disorder |
| F11.950 | Opioid use, unspecified with opioid-induced psychotic disorder with delusions |
| F11.951 | Opioid use, unspecified with opioid-induced psychotic disorder with hallucinations |
| F11.959 | Opioid use, unspecified with opioid-induced psychotic disorder, unspecified |
| F11.98 | Opioid use, unspecified with other specified opioid-induced disorder |
| F11.981 | Opioid use, unspecified with opioid-induced sexual dysfunction |
| F11.982 | Opioid use, unspecified with opioid-induced sleep disorder |
| F11.988 | Opioid use, unspecified with other opioid-induced disorder |
| F11.99 | Opioid use, unspecified with unspecified opioid-induced disorder |
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