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ICD-10 Guide
ICD-10 CodesF11.120

F11.120

Billable

Opioid abuse with intoxication, uncomplicated

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

Code Description

ICD-10 F11.120 is a billable code used to indicate a diagnosis of opioid abuse with intoxication, uncomplicated.

Key Diagnostic Point:

F11.120 refers to a diagnosis of opioid abuse characterized by the consumption of opioids in a manner that is harmful or hazardous, leading to intoxication without any complicating factors. This condition is part of a broader category of substance use disorders, where individuals may develop a psychological or physical dependence on opioids, which can include prescription pain relievers, heroin, and synthetic opioids. Intoxication manifests through various symptoms such as euphoria, drowsiness, and impaired coordination. The uncomplicated nature of this diagnosis indicates that the individual is not experiencing severe withdrawal symptoms, overdose, or any co-occurring mental health disorders at the time of assessment. Treatment typically involves counseling, behavioral therapies, and may include medication-assisted treatment (MAT) to help manage cravings and reduce the risk of relapse. Understanding the nuances of opioid abuse and its implications is crucial for effective treatment and recovery.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between uncomplicated and complicated cases.
  • Understanding the nuances of opioid types and their effects.
  • Recognizing co-occurring mental health disorders.
  • Navigating the documentation requirements for substance use disorders.

Audit Risk Factors

  • Inadequate documentation of the patient's history of opioid use.
  • Failure to document the absence of complicating factors.
  • Misclassification of the severity of intoxication.
  • Inconsistent coding with treatment plans and clinical notes.

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Comprehensive patient history, including substance use patterns and treatment history.

Common Clinical Scenarios

Patients presenting with opioid overdose, seeking detoxification, or entering rehabilitation programs.

Billing Considerations

Ensure accurate assessment of intoxication levels and any potential withdrawal symptoms.

Psychiatry

Documentation Requirements

Detailed mental health evaluations and treatment plans addressing both substance use and any co-occurring disorders.

Common Clinical Scenarios

Patients with opioid use disorder presenting with anxiety or depression.

Billing Considerations

Documenting the impact of opioid use on mental health and vice versa.

Coding Guidelines

Inclusion Criteria

Use F11.120 When
  • According to ICD
  • 10 guidelines, F11
  • 120 should be used when a patient exhibits signs of opioid abuse with intoxication but does not have any complicating factors such as withdrawal or overdose
  • Proper documentation of the patient's history and current condition is essential

Exclusion Criteria

Do NOT use F11.120 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0033CPT Code

Mental health counseling

Clinical Scenario

Used when providing therapy for opioid abuse.

Documentation Requirements

Document the nature of the counseling and the patient's response.

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 opioid-related disorders, improving the ability to track and manage opioid abuse cases effectively. F11.120 provides a clear distinction for uncomplicated intoxication, aiding in treatment planning and resource allocation.

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 cases effectively. F11.120 provides a clear distinction for uncomplicated intoxication, aiding in treatment planning and resource allocation.

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 cases effectively. F11.120 provides a clear distinction for uncomplicated intoxication, aiding in treatment planning 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 is the difference between opioid abuse and opioid dependence?

Opioid abuse refers to the harmful use of opioids without necessarily having a physical dependence, while opioid dependence involves a physical reliance on the substance, often characterized by withdrawal symptoms when not using.