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ICD-10 Guide
ICD-10 CodesF11.151

F11.151

Billable

Opioid abuse with opioid-induced psychotic disorder with hallucinations

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

Code Description

ICD-10 F11.151 is a billable code used to indicate a diagnosis of opioid abuse with opioid-induced psychotic disorder with hallucinations.

Key Diagnostic Point:

F11.151 refers to a condition characterized by the abuse of opioids, which leads to the development of a psychotic disorder specifically induced by the substance. This disorder is marked by the presence of hallucinations, which can be auditory, visual, or tactile in nature. Opioid abuse is a significant public health concern, often resulting in severe psychological and physical dependence. Patients may exhibit symptoms such as altered mental status, disorganized thinking, and impaired judgment. The psychotic features can complicate the clinical picture, making it essential for healthcare providers to differentiate between primary psychiatric disorders and those induced by substance use. Treatment typically involves a combination of detoxification, psychiatric intervention, and long-term rehabilitation strategies to address both the substance use disorder and the associated mental health issues. Effective management requires a multidisciplinary approach, including counseling, medication-assisted treatment, and ongoing support to prevent relapse and promote recovery.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between primary psychotic disorders and substance-induced disorders
  • Need for comprehensive documentation of substance use history
  • Potential for co-occurring mental health conditions
  • Variability in symptoms and severity among patients

Audit Risk Factors

  • Inadequate documentation of hallucinations or psychotic symptoms
  • Failure to document the severity and duration of opioid use
  • Lack of evidence for treatment plans addressing both substance use and psychosis
  • Misclassification of the primary diagnosis

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

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

Common Clinical Scenarios

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

Billing Considerations

Ensure clear documentation of the timeline of substance use and onset of psychotic symptoms.

Addiction Medicine

Documentation Requirements

Comprehensive substance use history, including previous treatment attempts and response to interventions.

Common Clinical Scenarios

Patients in withdrawal experiencing psychotic symptoms, necessitating a tailored treatment approach.

Billing Considerations

Documenting the use of medication-assisted treatment (MAT) and its impact on psychotic symptoms.

Coding Guidelines

Inclusion Criteria

Use F11.151 When
  • According to ICD
  • 10 guidelines, F11
  • 151 should be used when there is clear evidence of opioid abuse leading to a psychotic disorder with hallucinations
  • Documentation must support the diagnosis, including the timeline of substance use and the nature of psychotic symptoms

Exclusion Criteria

Do NOT use F11.151 When
  • Exclusion criteria include primary psychotic disorders not related to substance use

Related ICD-10 Codes

Related CPT Codes

99214CPT Code

Established patient office visit, level 4

Clinical Scenario

Used for follow-up visits in outpatient settings for patients with opioid-induced psychosis.

Documentation Requirements

Document the patient's history, current symptoms, and treatment response.

Specialty Considerations

Psychiatrists should ensure comprehensive mental status evaluations are included.

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, enhancing the ability to capture the complexity of conditions like F11.151. This specificity aids in better understanding the prevalence and treatment needs of affected populations.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, enhancing the ability to capture the complexity of conditions like F11.151. This specificity aids in better understanding the prevalence and treatment needs of affected populations.

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 F11.151 and F11.152?

F11.151 includes opioid-induced psychotic disorder with hallucinations, while F11.152 refers to the same disorder without hallucinations. Accurate documentation of symptoms is crucial for correct coding.