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ICD-10 Guide
ICD-10 CodesF11.188

F11.188

Billable

Opioid abuse with other opioid-induced disorder

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

Code Description

ICD-10 F11.188 is a billable code used to indicate a diagnosis of opioid abuse with other opioid-induced disorder.

Key Diagnostic Point:

F11.188 refers to a diagnosis of opioid abuse accompanied by other opioid-induced disorders. Opioid abuse is characterized by a pattern of opioid use that leads to significant impairment or distress, including recurrent use despite adverse consequences. The 'other opioid-induced disorder' may include conditions such as opioid-induced mood disorders, opioid-induced psychotic disorders, or other mental health issues stemming from opioid use. Patients may present with symptoms of withdrawal, intoxication, or other complications related to their opioid use. Treatment often involves a combination of behavioral therapies, medication-assisted treatment (MAT) such as buprenorphine or methadone, and psychosocial support. Accurate coding is essential for appropriate treatment planning and reimbursement, as well as for tracking the prevalence of opioid-related disorders in the healthcare system.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between opioid abuse and dependence
  • Identifying specific opioid-induced disorders
  • Documenting the severity and duration of symptoms
  • Understanding the patient's treatment history

Audit Risk Factors

  • Inadequate documentation of opioid use history
  • Failure to specify the type of opioid-induced disorder
  • Lack of evidence for the severity of abuse
  • Inconsistent coding with treatment plans

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Comprehensive history of substance use, including types of opioids used, duration, and impact on daily functioning.

Common Clinical Scenarios

Patients presenting with withdrawal symptoms, overdose, or co-occurring mental health disorders.

Billing Considerations

Ensure documentation reflects the complexity of the patient's condition and any co-occurring disorders.

Psychiatry

Documentation Requirements

Detailed mental health assessments, including mood and psychotic symptoms related to opioid use.

Common Clinical Scenarios

Patients experiencing depression or anxiety as a result of opioid abuse.

Billing Considerations

Document any psychiatric evaluations and treatment plans that address both substance use and mental health.

Coding Guidelines

Inclusion Criteria

Use F11.188 When
  • According to ICD
  • 10 coding guidelines, F11
  • 188 should be used when a patient has a documented history of opioid abuse along with other opioid
  • induced disorders
  • Coders must ensure that the documentation supports the diagnosis and that the opioid
  • induced disorder is clearly specified

Exclusion Criteria

Do NOT use F11.188 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0020CPT Code

Behavioral health counseling

Clinical Scenario

Used in conjunction with F11.188 for comprehensive treatment planning.

Documentation Requirements

Document the nature of counseling and its relation to opioid abuse.

Specialty Considerations

Addiction specialists should ensure that counseling sessions are tailored to address both substance use and mental health.

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, enabling better tracking of opioid abuse and its associated complications. F11.188 provides a clear framework for documenting the complexities of opioid abuse and its impact on mental health.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, enabling better tracking of opioid abuse and its associated complications. F11.188 provides a clear framework for documenting the complexities of opioid abuse and its impact on mental health.

Reimbursement & Billing Impact

reimbursement purposes.

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 that leads to significant impairment or distress, while opioid dependence involves a physical reliance on opioids, characterized by withdrawal symptoms when not using the substance.