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ICD-10 Guide
ICD-10 CodesF11.99

F11.99

Billable

Opioid use, unspecified with unspecified opioid-induced disorder

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

Code Description

ICD-10 F11.99 is a billable code used to indicate a diagnosis of opioid use, unspecified with unspecified opioid-induced disorder.

Key Diagnostic Point:

F11.99 refers to a condition characterized by the use of opioids without specification of the type or severity of the opioid-induced disorder. Opioid use disorder (OUD) is a complex condition that can manifest as a range of symptoms, including cravings, loss of control over use, and continued use despite negative consequences. Patients may experience withdrawal symptoms when not using opioids, which can include anxiety, nausea, and muscle pain. Intoxication can lead to respiratory depression, sedation, and overdose. Treatment options vary and may include behavioral therapies, medication-assisted treatment (MAT) with buprenorphine or methadone, and support groups. 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

  • Variability in opioid types and their effects
  • Differentiation between use, dependence, and withdrawal
  • Need for comprehensive patient history
  • Potential for co-occurring mental health disorders

Audit Risk Factors

  • Inadequate documentation of opioid use history
  • Failure to specify the type of opioid used
  • Lack of evidence for opioid-induced disorder symptoms
  • Inconsistent treatment documentation

Specialty Focus

Medical Specialties

Addiction Medicine

Documentation Requirements

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

Common Clinical Scenarios

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

Billing Considerations

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

Psychiatry

Documentation Requirements

Comprehensive mental health evaluations and treatment plans.

Common Clinical Scenarios

Patients with opioid use disorder presenting with anxiety, depression, or other mental health issues.

Billing Considerations

Documentation must reflect the interplay between opioid use and psychiatric symptoms.

Coding Guidelines

Inclusion Criteria

Use F11.99 When
  • According to ICD
  • 10 guidelines, F11
  • 99 should be used when the specific type of opioid or the severity of the disorder is not documented
  • Coders must ensure that the diagnosis aligns with the clinical documentation and that no more specific code is applicable

Exclusion Criteria

Do NOT use F11.99 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

H0020CPT Code

Behavioral health counseling

Clinical Scenario

Used in conjunction with F11.99 for outpatient therapy.

Documentation Requirements

Document the nature of counseling and patient progress.

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, improving the ability to track and manage these conditions. F11.99 serves as a catch-all for unspecified cases, but coders must strive for specificity when possible.

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. F11.99 serves as a catch-all for unspecified cases, but coders must strive for specificity when possible.

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. F11.99 serves as a catch-all for unspecified cases, but coders must strive for specificity when possible.

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

When should I use F11.99 instead of a more specific code?

F11.99 should be used when the specific type of opioid or the severity of the disorder is not documented, and no other more specific code applies.