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ICD-10 Guide
ICD-10 CodesF11.920

F11.920

Billable

Opioid use, unspecified with intoxication, uncomplicated

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

Code Description

ICD-10 F11.920 is a billable code used to indicate a diagnosis of opioid use, unspecified with intoxication, uncomplicated.

Key Diagnostic Point:

F11.920 refers to a diagnosis of opioid use disorder characterized by the use of opioids without specification of the type or source, accompanied by uncomplicated intoxication. This condition is marked by a pattern of opioid consumption that leads to significant impairment or distress, but without the presence of severe complications such as respiratory depression or coma. Patients may present with symptoms such as euphoria, drowsiness, and altered mental status. The uncomplicated nature of the intoxication indicates that the patient does not exhibit severe physiological or psychological symptoms that would necessitate more intensive medical intervention. Treatment often involves supportive care, monitoring, and potentially the use of opioid antagonists like naloxone in cases of overdose. Understanding the nuances of opioid use and its effects is crucial for effective management and coding, as it directly impacts treatment plans and healthcare outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in opioid types and their effects
  • Differentiation between uncomplicated and complicated intoxication
  • Need for comprehensive patient history to confirm diagnosis
  • Potential for co-occurring substance use disorders

Audit Risk Factors

  • Inadequate documentation of intoxication severity
  • Failure to specify opioid type when relevant
  • Lack of evidence for the diagnosis in the medical record
  • Misclassification of uncomplicated versus complicated intoxication

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Detailed patient history, including substance use patterns and treatment history.

Common Clinical Scenarios

Patients presenting with opioid intoxication in outpatient settings or during detoxification.

Billing Considerations

Consideration of withdrawal symptoms and potential for relapse; documentation of treatment plans and follow-up care.

Emergency Medicine

Documentation Requirements

Immediate assessment of intoxication symptoms, vital signs, and interventions provided.

Common Clinical Scenarios

Patients arriving in the emergency department with signs of opioid overdose or intoxication.

Billing Considerations

Timely documentation of interventions such as naloxone administration and patient response.

Coding Guidelines

Inclusion Criteria

Use F11.920 When
  • According to ICD
  • 10 coding guidelines, F11
  • 920 should be used when the patient presents with opioid use disorder and uncomplicated intoxication
  • It is essential to document the absence of severe symptoms and any relevant treatment provided

Exclusion Criteria

Do NOT use F11.920 When
  • Exclusion criteria include cases where the intoxication is complicated by other medical conditions

Related ICD-10 Codes

Related CPT Codes

99406CPT Code

Smoking and tobacco use cessation counseling visit

Clinical Scenario

Used in conjunction with opioid use disorder treatment to address co-occurring substance use.

Documentation Requirements

Document counseling provided and patient response.

Specialty Considerations

Addiction specialists may integrate tobacco cessation into opioid treatment plans.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of opioid use disorders, improving the ability to track and manage these conditions. F11.920 provides a clear framework for coding uncomplicated intoxication, facilitating better treatment planning and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of opioid use disorders, improving the ability to track and manage these conditions. F11.920 provides a clear framework for coding uncomplicated intoxication, facilitating better treatment planning and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of opioid use disorders, improving the ability to track and manage these conditions. F11.920 provides a clear framework for coding uncomplicated intoxication, facilitating 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 is the difference between F11.920 and F11.921?

F11.920 is used for uncomplicated opioid intoxication, while F11.921 is for complicated intoxication, which may involve severe symptoms requiring advanced medical intervention.