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ICD-10 Guide
ICD-10 CodesF11.22

F11.22

Billable

Opioid dependence with intoxication

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

Code Description

ICD-10 F11.22 is a billable code used to indicate a diagnosis of opioid dependence with intoxication.

Key Diagnostic Point:

Opioid dependence with intoxication is characterized by a pattern of opioid use leading to clinically significant impairment or distress, including tolerance and withdrawal symptoms. Intoxication refers to the acute effects of opioids, which may include euphoria, sedation, and respiratory depression. Patients may present with altered mental status, decreased respiratory rate, and potential overdose, necessitating immediate medical intervention. 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 typically involves a combination of pharmacotherapy, such as methadone or buprenorphine, and psychosocial interventions, including counseling and support groups. Accurate coding is essential for appropriate treatment planning and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between intoxication and withdrawal symptoms
  • Identifying co-occurring mental health disorders
  • Documenting the severity of dependence
  • Understanding the nuances of opioid types and their effects

Audit Risk Factors

  • Inadequate documentation of intoxication symptoms
  • Failure to document treatment plans and follow-up
  • Misclassification of opioid use disorder severity
  • Lack of evidence for co-occurring disorders

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Comprehensive assessment of substance use history, mental health evaluation, and treatment plan.

Common Clinical Scenarios

Patients presenting with overdose, withdrawal symptoms, or seeking treatment for opioid use disorder.

Billing Considerations

Ensure documentation reflects the severity of dependence and any co-occurring mental health issues.

Psychiatry

Documentation Requirements

Detailed psychiatric evaluation, including mental status examination and risk assessment.

Common Clinical Scenarios

Patients with opioid dependence experiencing mood disorders or anxiety.

Billing Considerations

Document any psychiatric comorbidities and their impact on treatment.

Coding Guidelines

Inclusion Criteria

Use F11.22 When
  • Follow the ICD
  • CM guidelines for substance use disorders, ensuring accurate documentation of the patient's history, symptoms, and treatment
  • Include details on the severity of dependence and any co
  • occurring conditions

Exclusion Criteria

Do NOT use F11.22 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0020CPT Code

Behavioral health counseling

Clinical Scenario

Used in conjunction with F11.22 for comprehensive treatment planning.

Documentation Requirements

Document the nature of counseling and its relation to opioid dependence.

Specialty Considerations

Addiction specialists should ensure that counseling sessions are well-documented.

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 dependence and its complications.

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 dependence and its complications.

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 dependence and its complications.

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 dependence with intoxication and opioid withdrawal?

Opioid dependence with intoxication refers to the acute effects of opioid use, including altered mental status and respiratory depression, while opioid withdrawal involves symptoms that occur when opioid use is reduced or stopped, such as anxiety, sweating, and nausea.