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ICD-10 Guide
ICD-10 CodesF11.23

F11.23

Billable

Opioid dependence with withdrawal

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

Code Description

ICD-10 F11.23 is a billable code used to indicate a diagnosis of opioid dependence with withdrawal.

Key Diagnostic Point:

Opioid dependence with withdrawal 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 higher doses to achieve the same effect, and experiences withdrawal symptoms when the substance is reduced or discontinued. Withdrawal symptoms can include anxiety, muscle aches, insomnia, sweating, nausea, and vomiting. The diagnosis is made based on clinical assessment, including the presence of withdrawal symptoms and the history of opioid use. Treatment often involves a combination of medication-assisted treatment (MAT) with buprenorphine or methadone, behavioral therapies, and support groups. The goal is to manage withdrawal symptoms, reduce cravings, and promote recovery. It is crucial for healthcare providers to recognize the signs of opioid dependence and withdrawal to initiate appropriate interventions and support the patient's journey toward recovery.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between opioid dependence and other substance use disorders.
  • Identifying withdrawal symptoms accurately.
  • Understanding the nuances of treatment plans and their documentation.
  • Navigating the regulations surrounding opioid prescriptions.

Audit Risk Factors

  • Inadequate documentation of withdrawal symptoms.
  • Failure to link treatment codes with the diagnosis.
  • Misclassification of opioid dependence severity.
  • Lack of evidence for ongoing treatment plans.

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Thorough documentation of patient history, withdrawal symptoms, treatment plans, and follow-up care.

Common Clinical Scenarios

Patients presenting with withdrawal symptoms, those in medication-assisted treatment programs, and individuals seeking detoxification.

Billing Considerations

Ensure accurate coding of both the diagnosis and any co-occurring mental health disorders.

Psychiatry

Documentation Requirements

Detailed mental health assessments, treatment progress notes, and documentation of any psychiatric comorbidities.

Common Clinical Scenarios

Patients with opioid dependence experiencing co-occurring mood disorders or anxiety.

Billing Considerations

Consider the impact of psychiatric medications on opioid withdrawal and dependence.

Coding Guidelines

Inclusion Criteria

Use F11.23 When
  • Follow the ICD
  • CM guidelines for substance use disorders, ensuring accurate documentation of withdrawal symptoms and treatment plans
  • Include any relevant co
  • occurring conditions in the coding

Exclusion Criteria

Do NOT use F11.23 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0020CPT Code

Behavioral health counseling

Clinical Scenario

Used in conjunction with F11.23 for patients receiving counseling as part of their treatment plan.

Documentation Requirements

Document the nature of counseling sessions and their relevance to opioid dependence.

Specialty Considerations

Addiction specialists should ensure that counseling is 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-related disorders, enhancing the ability to track and manage opioid dependence and withdrawal more effectively. This specificity aids in better treatment planning and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, enhancing the ability to track and manage opioid dependence and withdrawal more effectively. This specificity aids in better treatment planning and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, enhancing the ability to track and manage opioid dependence and withdrawal more effectively. This specificity aids in better treatment planning and resource allocation.

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 are the primary symptoms of opioid withdrawal?

Common symptoms of opioid withdrawal include anxiety, muscle aches, insomnia, sweating, nausea, vomiting, and diarrhea. These symptoms can vary in intensity and duration depending on the level of dependence.