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ICD-10 Guide
ICD-10 CodesF11.11

F11.11

Billable

Opioid abuse, in remission

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

Code Description

ICD-10 F11.11 is a billable code used to indicate a diagnosis of opioid abuse, in remission.

Key Diagnostic Point:

Opioid abuse, in remission, refers to a condition where an individual has previously engaged in the misuse of opioids but is currently not exhibiting any signs of active substance use disorder. This diagnosis is crucial for treatment planning and monitoring, as it indicates that the individual has made progress in their recovery journey. The remission status can be classified as either partial or full, depending on the absence of specific criteria related to opioid use. Individuals in remission may have undergone various treatment modalities, including behavioral therapies, medication-assisted treatment (MAT), and support groups. It is essential to document the duration of remission and any ongoing treatment or support mechanisms in place. This code is part of the broader category of substance use disorders, which encompasses a range of addictive behaviors and their associated health impacts. Accurate coding of this condition is vital for appropriate healthcare management, insurance reimbursement, and tracking the effectiveness of treatment interventions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between active opioid use and remission status
  • Understanding the nuances of remission definitions (partial vs. full)
  • Documenting previous substance use history accurately
  • Co-occurring mental health disorders that may complicate diagnosis

Audit Risk Factors

  • Inadequate documentation of remission status
  • Failure to specify the duration of remission
  • Misclassification of active use versus remission
  • Lack of supporting evidence for treatment history

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Detailed history of substance use, treatment interventions, and current status of remission.

Common Clinical Scenarios

Patients transitioning from active opioid use to recovery, those in outpatient treatment programs.

Billing Considerations

Consideration of co-occurring mental health disorders and the impact on treatment outcomes.

Psychiatry

Documentation Requirements

Comprehensive psychiatric evaluation, including substance use history and mental health status.

Common Clinical Scenarios

Patients with a history of opioid abuse presenting for mental health treatment.

Billing Considerations

Assessment of any ongoing psychological support or therapy related to substance use.

Coding Guidelines

Inclusion Criteria

Use F11.11 When
  • According to ICD
  • 10 coding guidelines, F11
  • 11 should be used when the patient has a documented history of opioid abuse but is currently in remission
  • It is essential to include the duration of remission and any ongoing treatment or support in the documentation

Exclusion Criteria

Do NOT use F11.11 When
  • Exclusion criteria include active opioid use or dependence

Related ICD-10 Codes

Related CPT Codes

H0038CPT Code

Alcohol and/or drug services, not otherwise specified

Clinical Scenario

Used when a patient in remission is receiving ongoing support services.

Documentation Requirements

Document the type of services provided and the patient's progress.

Specialty Considerations

Addiction specialists should ensure comprehensive treatment plans are in place.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including the ability to differentiate between active use and remission. This specificity aids in better tracking of treatment outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including the ability to differentiate between active use and remission. This specificity aids in better tracking of treatment outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including the ability to differentiate between active use and remission. This specificity aids in better tracking of treatment outcomes and resource allocation.

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 does 'in remission' mean in the context of opioid abuse?

In the context of opioid abuse, 'in remission' indicates that the individual has not met the criteria for opioid use disorder for a specified period, demonstrating progress in recovery. This status can be partial or full, depending on the absence of specific symptoms.