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ICD-10 Guide
ICD-10 CodesF11.98

F11.98

Billable

Opioid use, unspecified with other specified opioid-induced disorder

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

Code Description

ICD-10 F11.98 is a billable code used to indicate a diagnosis of opioid use, unspecified with other specified opioid-induced disorder.

Key Diagnostic Point:

F11.98 refers to a condition characterized by the use of opioids, which may lead to various opioid-induced disorders that are not specifically classified elsewhere. Opioid use disorder (OUD) is a complex condition that can manifest as addiction, dependence, withdrawal, or intoxication. Patients may experience a range of symptoms including cravings, loss of control over use, and continued use despite negative consequences. The unspecified nature of this code indicates that while the patient is experiencing an opioid-related disorder, the specific type of disorder (e.g., withdrawal, intoxication) is not detailed. Treatment often involves a combination of medication-assisted treatment (MAT), behavioral therapies, and support programs. Clinicians must carefully document the patient's history, symptoms, and treatment response to ensure accurate coding and appropriate care. This code is essential for capturing the nuances of opioid-related disorders in patients who may not fit neatly into more specific categories.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in opioid-induced disorders and symptoms.
  • Need for comprehensive patient history to determine the specific disorder.
  • Potential overlap with other substance use disorders.
  • Documentation requirements for treatment plans and outcomes.

Audit Risk Factors

  • Inadequate documentation of the specific opioid-induced disorder.
  • Failure to document the patient's treatment plan and response.
  • Misclassification of opioid use disorder severity.
  • Lack of follow-up documentation for ongoing treatment.

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

Detailed patient history, treatment plans, and progress notes.

Common Clinical Scenarios

Patients presenting with withdrawal symptoms, overdose, or seeking treatment for opioid use disorder.

Billing Considerations

Consideration of co-occurring mental health disorders and the need for integrated treatment approaches.

Psychiatry

Documentation Requirements

Comprehensive psychiatric evaluations and treatment notes.

Common Clinical Scenarios

Patients with opioid use disorder experiencing comorbid psychiatric conditions.

Billing Considerations

Documentation of mental health assessments and treatment modalities used.

Coding Guidelines

Inclusion Criteria

Use F11.98 When
  • According to ICD
  • 10 coding guidelines, F11
  • 98 should be used when a patient has an opioid use disorder that does not fit into a more specific category
  • Coders must ensure that the documentation supports the diagnosis and reflects the patient's clinical status

Exclusion Criteria

Do NOT use F11.98 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0020CPT Code

Behavioral health counseling and therapy

Clinical Scenario

Used in conjunction with F11.98 for patients receiving therapy for opioid use disorder.

Documentation Requirements

Document the type and duration of therapy provided.

Specialty Considerations

Consider the integration of behavioral health services in addiction treatment.

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, improving the ability to track and treat these conditions effectively. F11.98 captures a broader range of opioid use disorders, facilitating better patient management and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, improving the ability to track and treat these conditions effectively. F11.98 captures a broader range of opioid use disorders, facilitating better patient management and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of opioid-related disorders, improving the ability to track and treat these conditions effectively. F11.98 captures a broader range of opioid use disorders, facilitating better patient management 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 F11.98 and F11.20?

F11.98 is used for unspecified opioid use with other specified disorders, while F11.20 is for uncomplicated opioid dependence. F11.98 requires more detailed documentation to clarify the specific disorder.