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ICD-10 Guide
ICD-10 CodesF11.129

F11.129

Billable

Opioid abuse with intoxication, unspecified

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

Code Description

ICD-10 F11.129 is a billable code used to indicate a diagnosis of opioid abuse with intoxication, unspecified.

Key Diagnostic Point:

F11.129 refers to a diagnosis of opioid abuse characterized by the consumption of opioids leading to intoxication, without specification of the severity or type of opioid involved. Opioid abuse is a significant public health concern, often leading to addiction, withdrawal symptoms, and various health complications. Patients may present with altered mental status, euphoria, sedation, or respiratory depression due to the effects of opioids. The diagnosis is crucial for initiating appropriate treatment plans, which may include detoxification, medication-assisted treatment (MAT) with buprenorphine or methadone, and behavioral therapies. Accurate coding is essential for effective treatment and reimbursement, as it reflects the complexity of the patient's condition and the healthcare services provided. Clinicians must document the patient's history of opioid use, any previous treatment attempts, and the current state of intoxication to support the diagnosis and ensure comprehensive care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in opioid types and their effects
  • Need for detailed patient history and documentation
  • Differentiation between abuse and dependence
  • Potential for co-occurring mental health disorders

Audit Risk Factors

  • Inadequate documentation of opioid use history
  • Failure to specify the type of opioid involved
  • Lack of evidence for intoxication symptoms
  • Misclassification of abuse versus dependence

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Comprehensive patient history, including substance use patterns and previous treatments.

Common Clinical Scenarios

Patients presenting with overdose symptoms, withdrawal management, and relapse prevention.

Billing Considerations

Consideration of co-occurring mental health disorders and the need for integrated treatment plans.

Emergency Medicine

Documentation Requirements

Detailed account of presenting symptoms, vital signs, and interventions performed.

Common Clinical Scenarios

Patients arriving with acute opioid overdose or intoxication requiring immediate medical attention.

Billing Considerations

Rapid assessment and documentation are critical for timely intervention and accurate coding.

Coding Guidelines

Inclusion Criteria

Use F11.129 When
  • According to ICD
  • 10 guidelines, F11
  • 129 should be used when a patient is diagnosed with opioid abuse and exhibits signs of intoxication without further specification
  • Coders must ensure that documentation supports the diagnosis and reflects the patient's clinical status

Exclusion Criteria

Do NOT use F11.129 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0033CPT Code

Medication-assisted treatment

Clinical Scenario

Used when a patient is receiving buprenorphine for opioid abuse.

Documentation Requirements

Document the patient's treatment plan and progress notes.

Specialty Considerations

Addiction specialists should ensure comprehensive documentation of the treatment process.

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 accuracy of diagnoses and treatment plans. F11.129 reflects the need for precise documentation to capture the complexity of opioid abuse and its management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, improving the accuracy of diagnoses and treatment plans. F11.129 reflects the need for precise documentation to capture the complexity of opioid abuse and its management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, improving the accuracy of diagnoses and treatment plans. F11.129 reflects the need for precise documentation to capture the complexity of opioid abuse and its management.

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 meeting the criteria for dependence, while opioid dependence involves a physical and psychological reliance on opioids, often characterized by withdrawal symptoms when not using.