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v1.0.0
ICD-10 Guide
ICD-10 CodesF11.1

F11.1

Billable

Opioid abuse

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 F11.1 is a billable code used to indicate a diagnosis of opioid abuse.

Key Diagnostic Point:

Opioid abuse is characterized by a pattern of opioid use that leads to significant impairment or distress. This includes the recurrent use of opioids despite adverse consequences, such as legal issues, interpersonal problems, and health complications. Individuals may exhibit a strong desire to use opioids, increased tolerance, and withdrawal symptoms when not using the substance. Opioid abuse can lead to severe health risks, including overdose, which can be fatal. Treatment often involves a combination of behavioral therapies, counseling, and medication-assisted treatment (MAT) with agents such as buprenorphine or methadone. The clinical management of opioid abuse requires a comprehensive approach that addresses both the psychological and physical aspects of addiction, including the potential for co-occurring mental health disorders. Accurate coding is essential for appropriate treatment planning and reimbursement, as well as for tracking the prevalence of opioid-related issues in the healthcare system.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in patient presentation and severity of abuse
  • Need for comprehensive documentation of substance use history
  • Differentiation from opioid dependence and withdrawal
  • Potential for co-occurring mental health disorders

Audit Risk Factors

  • Inadequate documentation of substance use history
  • Failure to document treatment plans or follow-up care
  • Misclassification of opioid abuse as dependence
  • Lack of evidence for co-occurring disorders

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Detailed history of substance use, treatment plans, and progress notes.

Common Clinical Scenarios

Patients presenting with overdose, withdrawal symptoms, or seeking treatment for opioid use.

Billing Considerations

Documentation must clearly differentiate between abuse and dependence for accurate coding.

Psychiatry

Documentation Requirements

Comprehensive mental health evaluations and treatment plans addressing both substance use and mental health.

Common Clinical Scenarios

Patients with co-occurring mental health disorders and opioid abuse.

Billing Considerations

Consideration of dual diagnoses and their impact on treatment and coding.

Coding Guidelines

Inclusion Criteria

Use F11.1 When
  • Follow the ICD
  • CM guidelines for substance use disorders, ensuring accurate documentation of the patient's history and current status
  • Include any relevant co
  • occurring conditions

Exclusion Criteria

Do NOT use F11.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0031CPT Code

Mental health assessment

Clinical Scenario

Used when assessing a patient for opioid abuse.

Documentation Requirements

Document the assessment findings and treatment recommendations.

Specialty Considerations

Addiction specialists may require additional details on substance use history.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, improving the ability to track and manage opioid abuse in clinical settings.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, improving the ability to track and manage opioid abuse in clinical settings.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, improving the ability to track and manage opioid abuse in clinical settings.

Resources

Clinical References

  • •
    Substance Abuse and Mental Health Services Administration (SAMHSA)

Coding & Billing References

  • •
    Substance Abuse and Mental Health Services Administration (SAMHSA)

Frequently Asked Questions

What is the difference between opioid abuse and opioid dependence?

Opioid abuse refers to the harmful pattern of use without the presence of physical dependence, while opioid dependence includes tolerance and withdrawal symptoms.