ICD-10 Coding for Opioid Dependence(F11.20, F11.21)
Complete ICD-10-CM coding and documentation guide for Opioid Dependence. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Opioid Dependence
F11.2-Primary Range
Opioid dependence codes
This range includes all codes related to opioid dependence, including uncomplicated, in remission, and with complications like intoxication or withdrawal.
Long-term (current) use of opioid analgesic
This code is used for patients on long-term opioid therapy under medical supervision, not for dependence.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| F11.20 | Opioid dependence, uncomplicated | Use when there is documented opioid dependence without any complications. |
|
| F11.21 | Opioid dependence, in remission | Use when the patient is in sustained remission from opioid dependence. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for opioid dependence
Essential facts and insights about Opioid Dependence
Primary ICD-10-CM Codes for opioid dependence
Decision Criteria
clinical Criteria
- Presence of withdrawal symptoms not attributable to medical regimen
documentation Criteria
- Explicit mention of opioid dependence in clinical notes
Applicable To
- Opioid addiction without complications
Clinical Validation Requirements
- Documented maladaptive pattern of opioid use
- Evidence of tolerance or withdrawal symptoms
Code-Specific Risks
- Misclassification as Z79.891 when dependence is present
Coding Notes
- Ensure clear documentation of dependence versus long-term use under medical supervision.
F11.21 - Opioid dependence, in remission
Use when the patient is in sustained remission from opioid dependence.
Applicable To
- Sustained remission from opioid dependence
Excludes
- Current opioid use (F11.20)
Clinical Validation Requirements
- Documented abstinence from opioids for a significant period
- Regular negative urine drug screens
Coding Notes
Ensure documentation supports remission status with evidence of abstinence.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Poisoning by fentanyl, accidental
T40.421ADifferential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Opioid Dependence to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F11.20.
Impact
Clinical: Leads to misdiagnosis and inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials.
Mitigation Strategy
Use specific language from DSM-5 criteria., Regularly update documentation with patient status.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Misrepresentation of patient condition in records.
Mitigation Strategy
Use F11.20 for dependence, Z79.891 is for long-term use under medical supervision.
Impact
Incorrect use of Z79.891 instead of F11.20.
Mitigation Strategy
Regular training on ICD-10 coding guidelines.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Opioid Dependence, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Opioid Dependence
Use these documentation templates to ensure complete and accurate documentation for Opioid Dependence. These templates include all required elements for proper coding and billing.
MAT Initiation for Opioid Dependence
Specialty: Addiction MedicineRequired Elements
- Patient's last opioid use
- Current withdrawal symptoms
- Medication Assisted Treatment (MAT) plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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