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ICD-10 Guide
ICD-10 CodesF11.951

F11.951

Billable

Opioid use, unspecified with opioid-induced psychotic disorder with hallucinations

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

Code Description

ICD-10 F11.951 is a billable code used to indicate a diagnosis of opioid use, unspecified with opioid-induced psychotic disorder with hallucinations.

Key Diagnostic Point:

F11.951 refers to a condition characterized by the use of opioids, which are substances that can lead to addiction and various health complications. This specific code indicates that the individual is experiencing a psychotic disorder induced by opioid use, manifesting as hallucinations. Opioid-induced psychotic disorder is a serious mental health condition that can occur in individuals who misuse opioids, leading to altered perceptions of reality, including auditory or visual hallucinations. The condition is often associated with prolonged opioid use, withdrawal symptoms, or acute intoxication. Treatment typically involves a combination of psychiatric intervention, substance use disorder treatment, and possibly medication to manage symptoms. It is crucial for healthcare providers to document the severity and duration of opioid use, the presence of psychotic symptoms, and any co-occurring mental health disorders to ensure accurate coding and appropriate treatment planning.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between opioid use disorder and opioid-induced psychotic disorder.
  • Documenting the presence and type of hallucinations.
  • Understanding the nuances of unspecified opioid use.
  • Co-occurring mental health conditions complicating the diagnosis.

Audit Risk Factors

  • Inadequate documentation of opioid use history.
  • Failure to specify the type of hallucinations experienced.
  • Misclassification of the severity of the psychotic disorder.
  • Lack of evidence for the relationship between opioid use and psychotic symptoms.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed psychiatric evaluation notes, including symptom descriptions and duration.

Common Clinical Scenarios

Patients presenting with acute psychosis following opioid use, requiring hospitalization.

Billing Considerations

Psychiatrists must differentiate between primary psychotic disorders and those induced by substance use.

Addiction Medicine

Documentation Requirements

Comprehensive substance use history and treatment plans.

Common Clinical Scenarios

Patients in withdrawal experiencing psychotic symptoms needing detoxification.

Billing Considerations

Addiction specialists should document the treatment approach, including medication-assisted treatment.

Coding Guidelines

Inclusion Criteria

Use F11.951 When
  • According to ICD
  • 10 coding guidelines, F11
  • 951 should be used when there is clear documentation of opioid use and the presence of psychotic symptoms, specifically hallucinations
  • It is essential to ensure that the opioid use is documented as unspecified, and the psychotic disorder is directly linked to the opioid use

Exclusion Criteria

Do NOT use F11.951 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99214CPT Code

Established patient office visit, level 4

Clinical Scenario

Used for follow-up visits for patients with opioid-induced psychotic disorder.

Documentation Requirements

Document the patient's history, current symptoms, and treatment plan.

Specialty Considerations

Psychiatrists should ensure comprehensive mental status examinations are included.

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, including the differentiation of psychotic disorders induced by opioid use. This specificity aids in better tracking of treatment outcomes and resource allocation for substance use disorders.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, including the differentiation of psychotic disorders induced by opioid use. This specificity aids in better tracking of treatment outcomes and resource allocation for substance use disorders.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, including the differentiation of psychotic disorders induced by opioid use. This specificity aids in better tracking of treatment outcomes and resource allocation for substance use disorders.

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 significance of specifying 'with hallucinations' in F11.951?

Specifying 'with hallucinations' indicates the severity of the psychotic disorder and guides treatment decisions. It also ensures accurate coding for reimbursement and tracking of treatment outcomes.