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ICD-10 Guide
ICD-10 CodesF11.95

F11.95

Billable

Opioid use, unspecified with opioid-induced psychotic disorder

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

Code Description

ICD-10 F11.95 is a billable code used to indicate a diagnosis of opioid use, unspecified with opioid-induced psychotic disorder.

Key Diagnostic Point:

F11.95 refers to a condition characterized by the use of opioids, which may include prescription pain relievers, heroin, or synthetic opioids, leading to a psychotic disorder. This disorder manifests as hallucinations, delusions, or disorganized thinking, which are directly attributable to the effects of opioid use. The diagnosis of opioid-induced psychotic disorder is made when the psychotic symptoms occur during or shortly after opioid intoxication or withdrawal. The severity of the disorder can vary, and it may coexist with other substance use disorders, complicating the clinical picture. Treatment typically involves a combination of pharmacological interventions, such as the use of opioid antagonists, and psychosocial support, including counseling and rehabilitation programs. Accurate coding is essential for proper treatment planning and reimbursement, as it reflects the complexity of the patient's condition and the need for comprehensive care.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between opioid use disorder and opioid-induced psychotic disorder
  • Identifying the specific type of opioid used
  • Documenting the severity and duration of psychotic symptoms
  • Co-occurring mental health disorders that may complicate diagnosis

Audit Risk Factors

  • Inadequate documentation of psychotic symptoms
  • Failure to specify the type of opioid used
  • Misclassification of opioid use disorder severity
  • Lack of evidence for treatment interventions

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed psychiatric evaluation notes, including symptom assessment and treatment plans.

Common Clinical Scenarios

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

Billing Considerations

Ensure comprehensive documentation of both substance use history and mental health status.

Addiction Medicine

Documentation Requirements

Comprehensive substance use assessments, including history of opioid use and treatment history.

Common Clinical Scenarios

Patients in withdrawal experiencing psychotic symptoms, necessitating detoxification and stabilization.

Billing Considerations

Document the multidisciplinary approach to treatment, including counseling and medication-assisted treatment.

Coding Guidelines

Inclusion Criteria

Use F11.95 When
  • According to ICD
  • CM guidelines, F11
  • 95 should be used when the patient has a documented history of opioid use and exhibits psychotic symptoms
  • It is important to ensure that the symptoms are directly related to opioid use and not due to other underlying psychiatric conditions

Exclusion Criteria

Do NOT use F11.95 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-induced psychotic disorder.

Documentation Requirements

Comprehensive assessment notes detailing the patient's mental status and substance use history.

Specialty Considerations

Psychiatric evaluations should include specific inquiries about opioid use and associated symptoms.

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 differentiation of opioid-induced psychotic disorder from other substance use disorders, improving the accuracy of treatment and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, including the differentiation of opioid-induced psychotic disorder from other substance use disorders, improving the accuracy of treatment and reimbursement.

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 use disorder and opioid-induced psychotic disorder?

Opioid use disorder refers to a problematic pattern of opioid use leading to significant impairment or distress, while opioid-induced psychotic disorder specifically refers to the psychotic symptoms that arise directly from opioid use, such as hallucinations or delusions.