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ICD-10 Guide
ICD-10 CodesF11.281

F11.281

Billable

Opioid dependence with opioid-induced sexual dysfunction

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

Code Description

ICD-10 F11.281 is a billable code used to indicate a diagnosis of opioid dependence with opioid-induced sexual dysfunction.

Key Diagnostic Point:

Opioid dependence is characterized by a compulsive pattern of opioid use, leading to significant impairment or distress. Patients may experience withdrawal symptoms when not using opioids, and they often develop tolerance, requiring higher doses to achieve the same effect. Opioid-induced sexual dysfunction is a common complication of opioid use, manifesting as decreased libido, erectile dysfunction, or delayed ejaculation. This dysfunction can significantly impact the quality of life and interpersonal relationships of affected individuals. The interplay between opioid dependence and sexual dysfunction is complex, as the physiological effects of opioids can disrupt normal sexual functioning. Treatment often involves a combination of medication-assisted therapy (MAT) to manage opioid dependence, alongside counseling or therapy to address sexual health issues. Clinicians must carefully assess both the dependence and the sexual dysfunction to provide comprehensive care, which may include adjusting opioid dosages or exploring alternative pain management strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between opioid dependence and other substance use disorders.
  • Identifying and documenting the specific sexual dysfunction symptoms.
  • Understanding the interplay between opioid use and sexual health.
  • Navigating treatment options that may affect coding.

Audit Risk Factors

  • Inadequate documentation of opioid dependence.
  • Failure to document the specific type of sexual dysfunction.
  • Lack of evidence for treatment plans addressing both conditions.
  • Misclassification of opioid dependence severity.

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Detailed history of substance use, treatment history, and assessment of sexual dysfunction.

Common Clinical Scenarios

Patients presenting with opioid use disorder and complaints of sexual dysfunction.

Billing Considerations

Consideration of MAT options and their impact on sexual health.

Urology

Documentation Requirements

Assessment of sexual function, including specific tests and patient history.

Common Clinical Scenarios

Men with opioid dependence presenting with erectile dysfunction.

Billing Considerations

Coordination with addiction specialists for comprehensive care.

Coding Guidelines

Inclusion Criteria

Use F11.281 When
  • According to ICD
  • 10 guidelines, F11
  • 281 should be used when a patient has a documented opioid dependence diagnosis along with specific symptoms of sexual dysfunction
  • It is crucial to ensure that both conditions are clearly documented in the medical record

Exclusion Criteria

Do NOT use F11.281 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99406CPT Code

Smoking and tobacco use cessation counseling visit

Clinical Scenario

When a patient with opioid dependence also seeks help for smoking cessation.

Documentation Requirements

Document the patient's history of substance use and counseling provided.

Specialty Considerations

Addiction specialists may need to coordinate care with other providers.

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, including the ability to capture the nuances of opioid-induced sexual dysfunction, which was less clearly defined in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, including the ability to capture the nuances of opioid-induced sexual dysfunction, which was less clearly defined in ICD-9.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, including the ability to capture the nuances of opioid-induced sexual dysfunction, which was less clearly defined in ICD-9.

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 significance of coding F11.281?

Coding F11.281 is crucial for accurately capturing the complexities of opioid dependence and its impact on sexual health, which can guide treatment and improve patient outcomes.