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ICD-10 Guide
ICD-10 CodesF11.15

F11.15

Billable

Opioid abuse with opioid-induced psychotic disorder

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

Code Description

ICD-10 F11.15 is a billable code used to indicate a diagnosis of opioid abuse with opioid-induced psychotic disorder.

Key Diagnostic Point:

F11.15 refers to a condition characterized by the abuse of opioids, which leads to the development of a psychotic disorder as a direct consequence of opioid use. Opioid abuse is defined as the recurrent use of opioids despite adverse consequences, including social, occupational, or legal problems. The psychotic disorder may manifest as hallucinations, delusions, or disorganized thinking, which are directly attributable to the effects of opioids. This condition is particularly concerning due to the potential for severe impairment in functioning and the risk of harm to oneself or others. Diagnosis requires a thorough assessment, including a detailed history of substance use, mental health evaluation, and consideration of other potential causes of psychosis. Treatment typically involves a combination of pharmacotherapy, such as the use of opioid agonists or antagonists, and psychotherapy, focusing on substance use disorder management and addressing underlying psychological issues.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between opioid-induced psychotic disorder and primary psychotic disorders.
  • Need for comprehensive documentation of substance use history.
  • Potential for co-occurring mental health disorders complicating diagnosis.
  • Variability in presentation of psychotic symptoms based on opioid type and dosage.

Audit Risk Factors

  • Inadequate documentation of opioid use history.
  • Failure to document the severity and duration of psychotic symptoms.
  • Lack of evidence for the direct link between opioid use and psychotic symptoms.
  • Inconsistent coding of co-occurring mental health disorders.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed psychiatric evaluation, including mental status examination and substance use history.

Common Clinical Scenarios

Patients presenting with acute psychosis and a history of opioid use.

Billing Considerations

Consideration of differential diagnoses and the impact of withdrawal symptoms on mental status.

Addiction Medicine

Documentation Requirements

Comprehensive assessment of substance use patterns and treatment history.

Common Clinical Scenarios

Patients in withdrawal experiencing psychotic symptoms.

Billing Considerations

Integration of treatment plans addressing both addiction and mental health needs.

Coding Guidelines

Inclusion Criteria

Use F11.15 When
  • According to ICD
  • 10 guidelines, F11
  • 15 should be used when there is clear evidence of opioid abuse leading to psychotic symptoms
  • Documentation must support the diagnosis, including the timeline of substance use and onset of psychotic features

Exclusion Criteria

Do NOT use F11.15 When
  • Exclusion criteria include primary psychotic disorders not related to substance use

Related ICD-10 Codes

Related CPT Codes

99214CPT Code

Established patient office visit, level 4

Clinical Scenario

Used for follow-up visits for patients with opioid-induced psychotic disorder.

Documentation Requirements

Document the patient's history, mental status, and treatment plan.

Specialty Considerations

Psychiatric evaluations may require additional documentation of mental health assessments.

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 these conditions. F11.15 provides a clear distinction between opioid abuse with psychotic features and other substance use disorders.

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 these conditions. F11.15 provides a clear distinction between opioid abuse with psychotic features and other substance use disorders.

Reimbursement & Billing Impact

reimbursement.

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 includes a physical and psychological reliance on opioids, often characterized by withdrawal symptoms when not using.