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ICD-10 Guide
ICD-10 CodesF11.220

F11.220

Billable

Opioid dependence with intoxication, uncomplicated

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

Code Description

ICD-10 F11.220 is a billable code used to indicate a diagnosis of opioid dependence with intoxication, uncomplicated.

Key Diagnostic Point:

Opioid dependence with intoxication, uncomplicated, refers to a condition where an individual has developed a reliance on opioids, characterized by a compulsive pattern of use despite harmful consequences. This code is used when the individual is currently experiencing intoxication from opioids, which may manifest as euphoria, sedation, or altered mental status. The term 'uncomplicated' indicates that there are no additional complications such as withdrawal symptoms or co-occurring mental health disorders. Opioid dependence is a significant public health issue, often leading to severe health risks, including overdose and death. Treatment typically involves a combination of behavioral therapies and medications such as methadone or buprenorphine to manage dependence and reduce the risk of overdose. Accurate coding is essential for appropriate treatment planning and reimbursement, as well as for tracking the prevalence of opioid use disorders in the population.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between intoxication and withdrawal symptoms
  • Understanding the nuances of uncomplicated versus complicated cases
  • Navigating the overlap with other substance use disorders
  • Ensuring accurate documentation of the patient's history and current status

Audit Risk Factors

  • Inadequate documentation of the patient's opioid use history
  • Failure to specify the type of opioid involved
  • Misclassification of intoxication as withdrawal
  • Lack of supporting evidence for the diagnosis in the medical record

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Comprehensive documentation of the patient's substance use history, current medications, and treatment plan.

Common Clinical Scenarios

Patients presenting with acute intoxication, those in need of detoxification, or those seeking medication-assisted treatment.

Billing Considerations

Ensure that all relevant assessments and treatment plans are documented to support the diagnosis.

Psychiatry

Documentation Requirements

Detailed mental health evaluations, including any co-occurring disorders.

Common Clinical Scenarios

Patients with a history of opioid use disorder presenting with mood disorders or anxiety.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use F11.220 When
  • According to ICD
  • 10 guidelines, F11
  • 220 should be used when the patient meets the criteria for opioid dependence and is currently intoxicated without any complicating factors
  • Documentation must clearly indicate the patient's dependence and the nature of the intoxication

Exclusion Criteria

Do NOT use F11.220 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0020CPT Code

Behavioral health counseling

Clinical Scenario

Used in conjunction with F11.220 for counseling sessions addressing opioid use.

Documentation Requirements

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

Specialty Considerations

Addiction specialists should ensure that treatment plans are comprehensive.

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 dependence and its complications. F11.220 provides a clear distinction for uncomplicated cases, 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 dependence and its complications. F11.220 provides a clear distinction for uncomplicated cases, 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 dependence and its complications. F11.220 provides a clear distinction for uncomplicated cases, 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 F11.220 and F11.21?

F11.220 is used for opioid dependence with uncomplicated intoxication, while F11.21 is for cases where the patient is experiencing withdrawal symptoms.