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ICD-10 Guide
ICD-10 CodesF11.959

F11.959

Billable

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

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

Code Description

ICD-10 F11.959 is a billable code used to indicate a diagnosis of opioid use, unspecified with opioid-induced psychotic disorder, unspecified.

Key Diagnostic Point:

F11.959 refers to a diagnosis of opioid use disorder characterized by the presence of opioid-induced psychotic disorder, where the specifics of the opioid use are not clearly defined. Opioid use disorder is a chronic condition marked by an individual's inability to control their use of opioids, leading to significant impairment or distress. The psychotic disorder can manifest as hallucinations, delusions, or disorganized thinking, which are directly attributable to the use of opioids. This code is utilized when the clinician identifies the presence of psychotic symptoms but does not specify the type or extent of opioid use. Treatment often involves a combination of pharmacotherapy, such as methadone or buprenorphine, and psychosocial interventions, including cognitive-behavioral therapy and support groups. Accurate coding is crucial for appropriate treatment planning and reimbursement, as well as for tracking the prevalence of opioid-related disorders in the population.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Unspecified nature of opioid use complicates treatment planning.
  • Variability in psychotic symptoms can lead to misdiagnosis.
  • Need for comprehensive documentation to support the diagnosis.
  • Potential overlap with other substance use disorders.

Audit Risk Factors

  • Inadequate documentation of opioid use history.
  • Failure to document the severity of psychotic symptoms.
  • Lack of evidence for the diagnosis of opioid-induced psychotic disorder.
  • Inconsistent coding practices among providers.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed psychiatric evaluation notes, including history of substance use and mental health status.

Common Clinical Scenarios

Patients presenting with acute psychosis and a history of opioid use.

Billing Considerations

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

Addiction Medicine

Documentation Requirements

Comprehensive substance use assessments and treatment plans.

Common Clinical Scenarios

Patients undergoing detoxification or maintenance therapy for opioid use disorder.

Billing Considerations

Monitoring for withdrawal symptoms and adjusting treatment accordingly.

Coding Guidelines

Inclusion Criteria

Use F11.959 When
  • According to ICD
  • 10 guidelines, F11
  • 959 should be used when there is a clear diagnosis of opioid use disorder with psychotic features, but without specification of the opioid type or withdrawal symptoms
  • Documentation must support the diagnosis and reflect the patient's clinical status

Exclusion Criteria

Do NOT use F11.959 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0020CPT Code

Behavioral health counseling and therapy

Clinical Scenario

Used when providing therapy for patients with opioid use disorder and psychotic symptoms.

Documentation Requirements

Document the nature of the therapy and the patient's response.

Specialty Considerations

Psychiatrists and addiction specialists should ensure comprehensive notes on the patient's mental health status.

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. F11.959 provides a clear framework for identifying patients with opioid use and associated psychotic disorders, facilitating better treatment and research outcomes.

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. F11.959 provides a clear framework for identifying patients with opioid use and associated psychotic disorders, facilitating better treatment and research outcomes.

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 significance of using F11.959?

F11.959 is significant as it captures the complexity of opioid use disorder with psychotic features, allowing for appropriate treatment planning and resource allocation.