Opioid Use Disorder is defined by the DSM-5 as a “problematic pattern of opioid use…”
- A code of F11.20, opioid dependence, should not be assigned for patients taking pain medication as prescribed.
- Instead a code of Z79.891, long term use of opiates, should be assigned.
Coders should always be mindful of ICD-10 Guidelines and Coding Clinic Guidance when assigning codes for substance use disorder.
2021 ICD-10 Guidelines (pages 43-44)
Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01 – F99)
b. Mental and behavioral disorders due to psychoactive substance use
3. Psychoactive Substance Use, Unspecified
As with all other unspecified diagnoses, the codes for unspecified psychoactive substance use (F10.9-, F11.9-, F12.9-, F13.9-, F14.9-, F15.9-, F16.9-, F18.9-, F19.9-) should only be assigned based on provider documentation and when they meet the definition of a reportable diagnosis (see Section III, Reporting Additional Diagnoses). These codes are to be used only when the psychoactive substance use is associated with a physical disorder included in chapter 5 (such as sexual dysfunction and sleep disorder), or a mental or behavioral disorder, and such a relationship is documented by the provider.
AHA Coding Clinic Guidance
Question:
Medical record documentation indicates the patient is taking opioids prescribed by their physician for treatment of chronic pain. Does Guideline I.C.5.b.3. mean that codes cannot be assigned for the opioid use unless there is documentation of an associated physical, mental or behavioral disorder?
Answer:
A code for the use of prescription opiates would not be reported because there is no associated physical, mental or behavioral disorder.
Reference: AHA Coding Clinic 2018 2nd Quarter, pages 11 and 12
Learn more or download a copy of DSM-5 Criteria here https://erm365.org/opioid-use-disorder/
