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ICD-10 Guide
ICD-10 CodesF11.92

F11.92

Billable

Opioid use, unspecified with intoxication

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

Code Description

ICD-10 F11.92 is a billable code used to indicate a diagnosis of opioid use, unspecified with intoxication.

Key Diagnostic Point:

F11.92 refers to a condition characterized by the use of opioids, which are substances that act on the opioid receptors in the brain to produce morphine-like effects. This code is specifically used when there is evidence of intoxication, which may manifest as altered mental status, respiratory depression, or other physiological changes. Opioid use disorder is a complex condition that can lead to significant health complications, including overdose and death. The diagnosis of opioid use with intoxication requires careful assessment of the patient's history, including the type and amount of opioids used, the presence of any co-occurring mental health disorders, and the impact on daily functioning. Treatment often involves a combination of medical intervention, behavioral therapy, and support programs aimed at reducing opioid dependence and preventing relapse. Clinicians must document the specifics of the intoxication episode, including any interventions provided, to ensure accurate coding and appropriate treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in patient presentation and symptoms
  • Need for comprehensive patient history
  • Potential for co-occurring substance use disorders
  • Documentation of intoxication severity

Audit Risk Factors

  • Inadequate documentation of intoxication symptoms
  • Failure to differentiate between intoxication and withdrawal
  • Lack of comprehensive substance use history
  • Misuse of unspecified codes when more specific codes are available

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with overdose symptoms, requiring immediate intervention.

Billing Considerations

Consideration of co-occurring mental health disorders and the need for a multidisciplinary approach.

Emergency Medicine

Documentation Requirements

Immediate assessment of vital signs, level of consciousness, and interventions performed.

Common Clinical Scenarios

Patients presenting to the ER with suspected opioid overdose.

Billing Considerations

Rapid documentation is critical due to the acute nature of the condition.

Coding Guidelines

Inclusion Criteria

Use F11.92 When
  • According to ICD
  • 10 guidelines, F11
  • 92 should be used when there is clear evidence of opioid use with intoxication
  • Coders must ensure that the documentation supports the diagnosis and that the intoxication is not due to another substance

Exclusion Criteria

Do NOT use F11.92 When
  • Exclusion criteria include cases where the intoxication is clearly linked to another substance or condition

Related ICD-10 Codes

Related CPT Codes

99285CPT Code

Emergency department visit, high severity

Clinical Scenario

Used when a patient presents with opioid intoxication requiring immediate intervention.

Documentation Requirements

Detailed documentation of the patient's condition, interventions performed, and response to treatment.

Specialty Considerations

Emergency medicine specialists must ensure rapid and accurate documentation due to the acute nature of the presentation.

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 use disorders and their complications. F11.92 provides a clear designation for cases of opioid intoxication, which is critical for 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 use disorders and their complications. F11.92 provides a clear designation for cases of opioid intoxication, which is critical for treatment planning and resource allocation.

Reimbursement & Billing Impact

reimbursement.

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 intoxication and opioid withdrawal?

Opioid intoxication refers to the effects of consuming opioids, leading to symptoms such as drowsiness and respiratory depression. In contrast, opioid withdrawal occurs when a person who is dependent on opioids reduces or stops their use, leading to symptoms such as anxiety, nausea, and muscle aches.