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ICD-10 Guide
ICD-10 CodesF11.950

F11.950

Billable

Opioid use, unspecified with opioid-induced psychotic disorder with delusions

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

Code Description

ICD-10 F11.950 is a billable code used to indicate a diagnosis of opioid use, unspecified with opioid-induced psychotic disorder with delusions.

Key Diagnostic Point:

F11.950 refers to a condition characterized by the use of opioids, which are substances that can lead to addiction and various health complications. This specific code indicates that the individual is experiencing an opioid-induced psychotic disorder, which manifests as delusions. Delusions are false beliefs that are strongly held despite evidence to the contrary and can significantly impair an individual's ability to function. The psychotic disorder arises as a direct result of opioid use, which can alter brain chemistry and lead to severe mental health issues. Patients may exhibit symptoms such as hallucinations, paranoia, and disorganized thinking, which complicate their treatment and recovery. The management of this condition often requires a multidisciplinary approach, including psychiatric evaluation, substance use disorder treatment, and possibly medication to stabilize the patient's mental health. Understanding the interplay between opioid use and mental health is crucial for effective treatment and recovery.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between opioid use disorder and opioid-induced psychotic disorder
  • Identifying the presence of delusions and their impact on treatment
  • Navigating the nuances of substance use documentation
  • Understanding the implications of co-occurring mental health disorders

Audit Risk Factors

  • Inadequate documentation of the psychotic symptoms
  • Failure to specify the type of opioid used
  • Misclassification of the severity of the disorder
  • Lack of evidence for the presence of delusions

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed psychiatric evaluations, including mental status exams and history of substance use.

Common Clinical Scenarios

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

Billing Considerations

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

Addiction Medicine

Documentation Requirements

Comprehensive substance use history and treatment plans, including detoxification protocols.

Common Clinical Scenarios

Patients undergoing withdrawal management who exhibit psychotic symptoms.

Billing Considerations

Coordination with mental health services for integrated treatment approaches.

Coding Guidelines

Inclusion Criteria

Use F11.950 When
  • According to ICD
  • 10 coding guidelines, F11
  • 950 should be used when there is clear documentation of opioid use leading to a psychotic disorder with delusions
  • Coders must ensure that the documentation supports the diagnosis and that the symptoms are directly attributable to opioid use

Exclusion Criteria

Do NOT use F11.950 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99223CPT Code

Initial hospital care, typically 70 minutes or more

Clinical Scenario

Used when a patient with opioid-induced psychotic disorder is admitted for psychiatric care.

Documentation Requirements

Comprehensive history and examination, including mental status and substance use history.

Specialty Considerations

Psychiatrists should ensure that the documentation reflects the complexity of the case.

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 these conditions. F11.950 provides a clear framework for identifying patients with complex needs related to opioid use and mental health.

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 these conditions. F11.950 provides a clear framework for identifying patients with complex needs related to opioid use and mental health.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, improving the ability to track and manage these conditions. F11.950 provides a clear framework for identifying patients with complex needs related to opioid use and mental health.

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 documenting delusions in opioid use?

Documenting delusions is crucial as it directly impacts the treatment approach and the coding of the condition. It helps differentiate between opioid-induced psychotic disorder and other mental health disorders.