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ICD-10 Guide
ICD-10 CodesF11.259

F11.259

Billable

Opioid dependence with opioid-induced psychotic disorder, unspecified

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

Code Description

ICD-10 F11.259 is a billable code used to indicate a diagnosis of opioid dependence with opioid-induced psychotic disorder, unspecified.

Key Diagnostic Point:

Opioid dependence with opioid-induced psychotic disorder, unspecified (F11.259) refers to a condition where an individual has developed a dependence on opioids, leading to significant impairment or distress, and is experiencing psychotic symptoms as a direct result of opioid use. These psychotic symptoms may include hallucinations, delusions, or disorganized thinking. The unspecified nature of the code indicates that the specific type of psychotic disorder is not detailed in the documentation. Opioid dependence is characterized by a compulsive pattern of opioid use, tolerance, and withdrawal symptoms when the substance is not available. The presence of opioid-induced psychotic disorder complicates the clinical picture, as it may require immediate psychiatric intervention alongside substance use treatment. Treatment typically involves a combination of medication-assisted treatment (MAT) for opioid dependence, such as buprenorphine or methadone, and psychiatric care to address the psychotic symptoms. Comprehensive treatment programs often include counseling, behavioral therapies, and support groups to aid recovery and prevent relapse.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between opioid dependence and other substance use disorders
  • Identifying and documenting specific psychotic symptoms
  • Understanding the interplay between substance use and mental health
  • Navigating treatment options that address both addiction and psychosis

Audit Risk Factors

  • Inadequate documentation of psychotic symptoms
  • Failure to specify the type of opioid used
  • Lack of evidence for the diagnosis of opioid dependence
  • Insufficient treatment documentation

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Detailed history of substance use, treatment history, and current symptoms.

Common Clinical Scenarios

Patients presenting with withdrawal symptoms and psychosis, requiring immediate intervention.

Billing Considerations

Documentation must clearly outline the relationship between opioid use and psychotic symptoms.

Psychiatry

Documentation Requirements

Comprehensive psychiatric evaluation, including mental status examination and history of substance use.

Common Clinical Scenarios

Patients with a history of opioid use presenting with acute psychosis.

Billing Considerations

Psychiatric documentation should include the impact of opioid use on mental health.

Coding Guidelines

Inclusion Criteria

Use F11.259 When
  • According to ICD
  • 10 guidelines, F11
  • 259 should be used when there is clear documentation of opioid dependence accompanied by psychotic symptoms
  • It is essential to ensure that the psychotic disorder is directly linked to opioid use

Exclusion Criteria

Do NOT use F11.259 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0033CPT Code

Mental health assessment

Clinical Scenario

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

Documentation Requirements

Document the assessment findings and treatment plan.

Specialty Considerations

Addiction specialists should ensure comprehensive evaluations are performed.

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 treat these complex conditions effectively.

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 treat these complex conditions effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, improving the ability to track and treat these complex conditions effectively.

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 specifically involves the presence of psychotic symptoms as a direct result of opioid use.