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ICD-10 Guide
ICD-10 CodesF11.94

F11.94

Billable

Opioid use, unspecified with opioid-induced mood disorder

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

Code Description

ICD-10 F11.94 is a billable code used to indicate a diagnosis of opioid use, unspecified with opioid-induced mood disorder.

Key Diagnostic Point:

F11.94 refers to a diagnosis of opioid use disorder that is unspecified, accompanied by a mood disorder induced by the use of opioids. This condition is characterized by a problematic pattern of opioid use leading to significant impairment or distress, which may manifest as mood disturbances such as depression or anxiety. Opioid-induced mood disorder can occur due to the pharmacological effects of opioids on the brain's neurotransmitter systems, particularly serotonin and dopamine pathways. Patients may experience symptoms such as persistent sadness, irritability, or anhedonia, which can complicate the management of their substance use disorder. Treatment typically involves a combination of behavioral therapies, medication-assisted treatment (MAT) with buprenorphine or methadone, and psychosocial support. Accurate coding is essential for appropriate treatment planning and reimbursement, as well as for tracking the prevalence and outcomes of opioid use disorders in clinical settings.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in opioid use patterns and associated mood disorders.
  • Need for comprehensive documentation of substance use history.
  • Differentiation between primary mood disorders and those induced by opioids.
  • Potential for co-occurring mental health conditions.

Audit Risk Factors

  • Inadequate documentation of opioid use history.
  • Failure to specify the type of opioid used.
  • Lack of evidence for mood disorder diagnosis.
  • Inconsistent treatment documentation.

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Detailed history of substance use, including types and amounts of opioids used, duration of use, and previous treatment attempts.

Common Clinical Scenarios

Patients presenting with opioid overdose, withdrawal symptoms, or seeking treatment for opioid use disorder.

Billing Considerations

Consideration of co-occurring mental health disorders and the need for integrated treatment approaches.

Psychiatry

Documentation Requirements

Comprehensive psychiatric evaluation including mood disorder assessment and history of substance use.

Common Clinical Scenarios

Patients with mood disorders who have a history of opioid use or are currently using opioids.

Billing Considerations

Differentiating between primary mood disorders and those secondary to substance use.

Coding Guidelines

Inclusion Criteria

Use F11.94 When
  • According to ICD
  • 10 guidelines, F11
  • 94 should be used when there is a documented opioid use disorder with mood disorder symptoms
  • It is important to ensure that the mood disorder is directly linked to opioid use and not due to other underlying psychiatric conditions

Exclusion Criteria

Do NOT use F11.94 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 use disorder and mood symptoms.

Documentation Requirements

Document the assessment findings, including mood symptoms and substance use history.

Specialty Considerations

Addiction specialists may require additional details on 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 use disorders, improving the ability to track and manage these conditions. F11.94 provides a clear framework for identifying patients with opioid use and associated mood disorders, facilitating better treatment and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of opioid use disorders, improving the ability to track and manage these conditions. F11.94 provides a clear framework for identifying patients with opioid use and associated mood disorders, facilitating better 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 F11.94 and F11.20?

F11.94 is used for opioid use disorder with mood disorder symptoms, while F11.20 is specifically for opioid withdrawal. Accurate documentation is essential to determine the appropriate code.