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ICD-10 Guide
ICD-10 CodesF11.221

F11.221

Billable

Opioid dependence with intoxication delirium

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

Code Description

ICD-10 F11.221 is a billable code used to indicate a diagnosis of opioid dependence with intoxication delirium.

Key Diagnostic Point:

Opioid dependence with intoxication delirium is characterized by a compulsive pattern of opioid use, leading to significant impairment or distress. This condition arises when an individual develops a tolerance to opioids, requiring increased doses to achieve the desired effect. Intoxication delirium occurs when the individual experiences acute confusion, altered consciousness, and cognitive disturbances due to the effects of opioids. Symptoms may include disorientation, hallucinations, and severe agitation. The diagnosis necessitates a thorough assessment of the patient's history, including the duration and quantity of opioid use, as well as any co-occurring mental health disorders. Treatment typically involves a combination of pharmacological interventions, such as opioid agonists or antagonists, and psychosocial support, including counseling and rehabilitation programs. The complexity of managing opioid dependence with intoxication delirium lies in the need for a multidisciplinary approach to address both the physiological and psychological aspects of addiction.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between intoxication and withdrawal symptoms
  • Need for comprehensive patient history and documentation
  • Potential for co-occurring mental health disorders
  • Variability in treatment protocols across settings

Audit Risk Factors

  • Inadequate documentation of intoxication symptoms
  • Failure to document the patient's treatment plan
  • Lack of evidence for co-occurring disorders
  • Inconsistent coding of related conditions

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Detailed history of substance use, treatment history, and mental health evaluation.

Common Clinical Scenarios

Patients presenting with acute intoxication, withdrawal symptoms, or complications from opioid use.

Billing Considerations

Documentation must clearly differentiate between intoxication and withdrawal to ensure accurate coding.

Psychiatry

Documentation Requirements

Comprehensive mental health assessment, including cognitive function tests and history of psychiatric disorders.

Common Clinical Scenarios

Patients with opioid dependence presenting with psychotic symptoms or severe mood disturbances.

Billing Considerations

Psychiatric evaluations must include assessments of delirium and its impact on treatment.

Coding Guidelines

Inclusion Criteria

Use F11.221 When
  • According to ICD
  • 10 guidelines, F11
  • 221 should be used when the patient meets the criteria for opioid dependence and exhibits symptoms of intoxication delirium
  • Documentation must support the diagnosis, including clinical observations and treatment plans

Exclusion Criteria

Do NOT use F11.221 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0020CPT Code

Behavioral health counseling

Clinical Scenario

Used in conjunction with F11.221 for comprehensive treatment.

Documentation Requirements

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

Specialty Considerations

Addiction specialists should ensure that counseling sessions are tailored to the patient's specific needs.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of opioid dependence and its complications, improving the accuracy of diagnoses and treatment tracking. F11.221 provides a clear distinction between opioid dependence with and without delirium, facilitating better patient management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of opioid dependence and its complications, improving the accuracy of diagnoses and treatment tracking. F11.221 provides a clear distinction between opioid dependence with and without delirium, facilitating better patient management.

Reimbursement & Billing Impact

reimbursement and compliance with regulatory standards.

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 and opioid use disorder?

Opioid dependence is a specific type of opioid use disorder characterized by physical dependence on opioids, while opioid use disorder encompasses a broader range of behaviors and symptoms related to opioid misuse.