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ICD-10 Guide
ICD-10 CodesF11.93

F11.93

Billable

Opioid use, unspecified with withdrawal

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

Code Description

ICD-10 F11.93 is a billable code used to indicate a diagnosis of opioid use, unspecified with withdrawal.

Key Diagnostic Point:

F11.93 refers to a condition characterized by the use of opioids, which are substances that act on the nervous system to relieve pain but can lead to physical dependence and withdrawal symptoms when usage is reduced or stopped. This code is used when the specific type of opioid is not specified, and the patient is experiencing withdrawal symptoms. Withdrawal symptoms can include anxiety, muscle aches, insomnia, sweating, and gastrointestinal distress. The diagnosis of opioid use disorder is based on a pattern of opioid use leading to significant impairment or distress, and withdrawal symptoms indicate a physiological dependence on the substance. Treatment often involves a combination of behavioral therapies and medications, such as methadone or buprenorphine, to manage withdrawal symptoms and reduce cravings. Accurate coding is essential for appropriate treatment planning and reimbursement, as well as for tracking the prevalence of opioid use disorders in the population.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Unspecified nature of opioid use complicates treatment planning.
  • Withdrawal symptoms can vary widely among individuals.
  • Differentiating between opioid use disorder and other substance use disorders.
  • Need for comprehensive documentation to support the diagnosis.

Audit Risk Factors

  • Inadequate documentation of withdrawal symptoms.
  • Failure to specify the type of opioid used.
  • Lack of evidence for the diagnosis of opioid use disorder.
  • Inconsistent coding practices across providers.

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Detailed history of substance use, withdrawal symptoms, and treatment plan.

Common Clinical Scenarios

Patients presenting with withdrawal symptoms after cessation of opioid use.

Billing Considerations

Consideration of co-occurring mental health disorders and comprehensive treatment approaches.

Psychiatry

Documentation Requirements

Mental health evaluation, history of substance use, and assessment of withdrawal severity.

Common Clinical Scenarios

Patients with a history of opioid use presenting with anxiety or depression.

Billing Considerations

Integration of psychiatric care with addiction treatment for optimal outcomes.

Coding Guidelines

Inclusion Criteria

Use F11.93 When
  • According to ICD
  • 10 coding guidelines, F11
  • 93 should be used when the patient has a documented history of opioid use and is experiencing withdrawal symptoms
  • It is important to ensure that the diagnosis is supported by clinical documentation, including the severity and duration of withdrawal symptoms

Exclusion Criteria

Do NOT use F11.93 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0020CPT Code

Behavioral health counseling

Clinical Scenario

Used in conjunction with F11.93 for patients receiving counseling during withdrawal.

Documentation Requirements

Document the nature of counseling and its relation to withdrawal symptoms.

Specialty Considerations

Addiction specialists should ensure comprehensive treatment plans are 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 use disorders, including withdrawal symptoms. This specificity aids in better tracking and treatment of these conditions, improving patient care and outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of opioid use disorders, including withdrawal symptoms. This specificity aids in better tracking and treatment of these conditions, improving patient care and outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of opioid use disorders, including withdrawal symptoms. This specificity aids in better tracking and treatment of these conditions, improving patient care and outcomes.

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 key symptoms of opioid withdrawal?

Key symptoms of opioid withdrawal include anxiety, muscle aches, insomnia, sweating, nausea, vomiting, and diarrhea. These symptoms can vary in severity and duration depending on the individual's level of dependence.