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ICD-10 Guide
ICD-10 CodesF11.159

F11.159

Billable

Opioid abuse with opioid-induced psychotic disorder, unspecified

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

Code Description

ICD-10 F11.159 is a billable code used to indicate a diagnosis of opioid abuse with opioid-induced psychotic disorder, unspecified.

Key Diagnostic Point:

F11.159 refers to a condition characterized by the abuse of opioids, leading to a psychotic disorder that is induced by the substance. Opioid abuse is a significant public health issue, often resulting in severe psychological and physical health consequences. Patients may experience hallucinations, delusions, and other psychotic symptoms as a direct result of opioid use. The unspecified nature of the psychotic disorder indicates that the specific type of psychosis is not clearly defined, which can complicate treatment and management. Treatment typically involves a combination of pharmacological interventions, such as the use of opioid antagonists, and psychosocial support, including counseling and rehabilitation programs. The complexity of managing opioid-induced psychotic disorders lies in the need for careful assessment of the patient's substance use history, mental health status, and the potential for withdrawal symptoms, which can further complicate the clinical picture.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between opioid-induced psychosis and primary psychotic disorders.
  • Assessing the severity of opioid abuse and its impact on mental health.
  • Navigating the nuances of withdrawal symptoms versus psychotic symptoms.
  • Understanding the interplay between opioid use and co-occurring mental health disorders.

Audit Risk Factors

  • Inadequate documentation of the patient's substance use history.
  • Failure to specify the nature of the psychotic disorder.
  • Lack of evidence for the relationship between opioid use and psychotic symptoms.
  • Insufficient follow-up documentation regarding treatment outcomes.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed mental health assessments, including history of substance use and current symptoms.

Common Clinical Scenarios

Patients presenting with acute psychosis following opioid use, or those with a history of opioid abuse and ongoing psychotic symptoms.

Billing Considerations

Careful monitoring of medication interactions and potential for withdrawal symptoms during treatment.

Addiction Medicine

Documentation Requirements

Comprehensive substance use evaluations, including screening tools and treatment plans.

Common Clinical Scenarios

Patients in detoxification programs experiencing psychotic symptoms, or those in long-term recovery with relapse episodes.

Billing Considerations

Integration of mental health treatment with addiction recovery strategies.

Coding Guidelines

Inclusion Criteria

Use F11.159 When
  • According to ICD
  • 10 coding guidelines, F11
  • 159 should be used when there is clear documentation of opioid abuse leading to psychotic symptoms
  • It is essential to differentiate this from other mental health disorders and to document the specific nature of the psychotic symptoms

Exclusion Criteria

Do NOT use F11.159 When
No specific exclusions found.

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 psychosis.

Documentation Requirements

Document the patient's history, current symptoms, and treatment plan.

Specialty Considerations

Psychiatrists should ensure comprehensive mental health assessments are included.

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. F11.159 provides a clear framework for identifying patients with opioid-induced psychosis, facilitating targeted treatment and research.

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. F11.159 provides a clear framework for identifying patients with opioid-induced psychosis, facilitating targeted treatment and research.

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 these conditions. F11.159 provides a clear framework for identifying patients with opioid-induced psychosis, facilitating targeted treatment and research.

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-induced psychosis and primary psychotic disorders?

Opioid-induced psychosis occurs as a direct result of opioid use, while primary psychotic disorders, such as schizophrenia, are not caused by substance use. Accurate diagnosis requires careful assessment of the patient's substance use history and the timing of symptom onset.