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ICD-10 Guide
ICD-10 CodesF11.250

F11.250

Billable

Opioid dependence with opioid-induced psychotic disorder with delusions

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

Code Description

ICD-10 F11.250 is a billable code used to indicate a diagnosis of opioid dependence with opioid-induced psychotic disorder with delusions.

Key Diagnostic Point:

Opioid dependence with opioid-induced psychotic disorder with delusions is characterized by a pattern of opioid use leading to clinically significant impairment or distress, accompanied by the presence of psychotic symptoms such as delusions that are directly attributable to the use of opioids. This condition often arises in individuals who have developed a tolerance to opioids and may experience withdrawal symptoms when not using the substance. The delusions can manifest as false beliefs that are firmly held despite contradictory evidence, often leading to significant functional impairment. The diagnosis requires a thorough assessment to differentiate between primary psychotic disorders and those induced by substance use. Treatment typically involves a combination of pharmacotherapy, such as methadone or buprenorphine, and psychosocial interventions, including cognitive behavioral therapy and support groups. The complexity of managing this condition lies in addressing both the substance dependence and the associated psychotic symptoms, necessitating a multidisciplinary approach to care.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between primary psychotic disorders and substance-induced disorders
  • Need for comprehensive documentation of substance use history
  • Potential for co-occurring mental health disorders
  • Variability in presentation of psychotic symptoms

Audit Risk Factors

  • Inadequate documentation of psychotic symptoms
  • Failure to document the relationship between opioid use and psychosis
  • Lack of comprehensive substance use history
  • Inconsistent coding of co-occurring mental health conditions

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

Need for careful monitoring of both psychiatric and substance use treatment outcomes.

Addiction Medicine

Documentation Requirements

Comprehensive assessment of substance use patterns, including frequency, quantity, and impact on functioning.

Common Clinical Scenarios

Patients in withdrawal experiencing psychotic symptoms.

Billing Considerations

Integration of addiction treatment with mental health services.

Coding Guidelines

Inclusion Criteria

Use F11.250 When
  • According to ICD
  • 10 guidelines, this code should be used when there is clear evidence of opioid dependence accompanied by psychotic symptoms
  • Documentation must support the diagnosis, including the timeline of opioid use and the onset of psychotic symptoms

Exclusion Criteria

Do NOT use F11.250 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0031CPT Code

Mental health assessment

Clinical Scenario

Used when assessing a patient with opioid dependence and psychotic symptoms.

Documentation Requirements

Comprehensive assessment notes detailing mental status and substance use history.

Specialty Considerations

Psychiatrists should ensure thorough documentation to support the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including the differentiation of opioid-induced psychotic disorders, which enhances the accuracy of treatment and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of substance use disorders, including the differentiation of opioid-induced psychotic disorders, which enhances the accuracy of treatment and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

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 dependence and opioid-induced psychotic disorder?

Opioid dependence refers to the compulsive use of opioids leading to significant impairment, while opioid-induced psychotic disorder is characterized by the presence of psychotic symptoms, such as delusions, that are directly related to opioid use.