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ICD-10 Guide
ICD-10 CodesF11.251

F11.251

Billable

Opioid dependence with opioid-induced psychotic disorder with hallucinations

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

Code Description

ICD-10 F11.251 is a billable code used to indicate a diagnosis of opioid dependence with opioid-induced psychotic disorder with hallucinations.

Key Diagnostic Point:

F11.251 refers to a condition characterized by a dependence on opioids, which are substances that act on the nervous system to relieve pain but can lead to addiction. This specific code indicates that the individual is experiencing a psychotic disorder as a direct result of opioid use, manifesting in hallucinations. Hallucinations can involve seeing, hearing, or feeling things that are not present, significantly impacting the individual's perception of reality. Opioid dependence is marked by a compulsive pattern of opioid use, leading to significant impairment or distress. The psychotic disorder may present with symptoms such as delusions, disorganized thinking, and impaired functioning. Treatment typically involves a combination of medication-assisted treatment (MAT) to manage withdrawal symptoms and cravings, along with psychotherapy to address the psychological aspects of addiction. Understanding the interplay between opioid dependence and induced psychotic disorders is crucial for effective treatment and management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between opioid dependence and other substance use disorders
  • Identifying the presence of psychotic symptoms specifically induced by opioids
  • Documenting the severity and duration of hallucinations
  • Understanding the nuances of treatment plans that may involve multiple specialties

Audit Risk Factors

  • Inadequate documentation of psychotic symptoms
  • Failure to specify the type of hallucinations experienced
  • Lack of evidence for opioid dependence diagnosis
  • Inconsistent coding with treatment plans

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed psychiatric evaluations, including mental status exams and history of substance use.

Common Clinical Scenarios

Patients presenting with acute psychosis following opioid use, requiring hospitalization.

Billing Considerations

Ensure clear documentation of the relationship between opioid use and psychotic symptoms.

Addiction Medicine

Documentation Requirements

Comprehensive substance use history, treatment plans, and progress notes.

Common Clinical Scenarios

Patients undergoing detoxification and rehabilitation for opioid dependence with psychotic features.

Billing Considerations

Document the use of medication-assisted treatment and its effects on psychotic symptoms.

Coding Guidelines

Inclusion Criteria

Use F11.251 When
  • According to ICD
  • 10 coding guidelines, F11
  • 251 should be used when there is clear documentation of opioid dependence accompanied by psychotic symptoms, specifically hallucinations
  • It is essential to ensure that the psychotic disorder is directly linked to opioid use and not due to other underlying mental health conditions

Exclusion Criteria

Do NOT use F11.251 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 mental health evaluation notes.

Specialty Considerations

Psychiatrists should ensure thorough documentation of the patient's substance use history.

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, such as psychotic disorders. This specificity aids in better 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, such as psychotic disorders. This specificity aids in better 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, such as psychotic disorders. This specificity aids in better 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 opioid dependence and opioid use disorder?

Opioid dependence refers specifically to the physiological adaptation to opioids, leading to withdrawal symptoms when not using. Opioid use disorder encompasses a broader range of behavioral and psychological issues related to opioid use, including dependence.