ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesF11.12

F11.12

Billable

Opioid abuse with intoxication

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

Code Description

ICD-10 F11.12 is a billable code used to indicate a diagnosis of opioid abuse with intoxication.

Key Diagnostic Point:

Opioid abuse with intoxication refers to a pattern of opioid use that leads to significant impairment or distress, characterized by the consumption of opioids in excess of prescribed amounts or for non-medical purposes. This condition is marked by the presence of intoxication symptoms, which may include euphoria, drowsiness, respiratory depression, and altered mental status. Individuals may exhibit behavioral changes, such as increased secrecy, withdrawal from social activities, and neglect of responsibilities. The diagnosis requires a thorough assessment of the patient's history, including the frequency and quantity of opioid use, as well as any co-occurring mental health disorders. Treatment often involves a combination of behavioral therapies, counseling, and medication-assisted treatment (MAT) to manage withdrawal symptoms and reduce cravings. The complexity of this diagnosis lies in the need for comprehensive documentation of the patient's substance use history and the impact on their daily functioning.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variability in patient presentation and symptoms
  • Need for detailed documentation of substance use history
  • Potential for co-occurring mental health disorders
  • Differentiation from other substance use disorders

Audit Risk Factors

  • Inadequate documentation of intoxication symptoms
  • Failure to document the severity of opioid use
  • Lack of evidence for treatment plans
  • Misclassification of opioid use disorder severity

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Comprehensive assessment of substance use history, including duration, frequency, and impact on daily life.

Common Clinical Scenarios

Patients presenting with overdose symptoms, withdrawal management, and those seeking detoxification.

Billing Considerations

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

Psychiatry

Documentation Requirements

Detailed mental health evaluation, including assessment of mood, behavior, and cognitive function.

Common Clinical Scenarios

Patients with dual diagnoses of opioid use disorder and mood disorders, requiring integrated treatment plans.

Billing Considerations

Importance of documenting the patient's mental status and any changes in behavior related to opioid use.

Coding Guidelines

Inclusion Criteria

Use F11.12 When
  • According to ICD
  • 10 guidelines, F11
  • 12 should be used when there is clear evidence of opioid abuse accompanied by intoxication
  • Documentation must support the diagnosis, including clinical findings and treatment plans

Exclusion Criteria

Do NOT use F11.12 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0020CPT Code

Behavioral health counseling

Clinical Scenario

Used in conjunction with F11.12 for patients receiving counseling for opioid abuse.

Documentation Requirements

Document the type and duration of counseling provided.

Specialty Considerations

Ensure that the counseling aligns with the treatment plan for opioid use disorder.

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 abuse and its consequences in clinical practice.

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 abuse and its consequences in clinical practice.

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 opioid abuse and its consequences in clinical practice.

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 abuse and opioid dependence?

Opioid abuse refers to the misuse of opioids leading to significant impairment, while opioid dependence involves a physical reliance on opioids, often characterized by withdrawal symptoms when not using the substance.