F11.181
BillableOpioid abuse with opioid-induced sexual dysfunction
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F11.181 an HCC code?
Yes. F11.181 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Dependence under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for F11.181
For F11.181 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed F11.181 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F11.181 is the ICD-10-CM diagnosis code for opioid abuse with opioid-induced sexual dysfunction. A person who misuses opioids and experiences sexual dysfunction (such as erectile dysfunction or decreased sexual desire) as a direct effect of the opioid use. F11.181 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering mental and behavioral disorders due to psychoactive substance use (f10-f19).
Under the CMS-HCC V28 risk adjustment model, F11.181 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe (HCC 137) with a community, non-dual, aged base RAF weight of 0.358. Under the older CMS-HCC V24 model, F11.181 maps to Drug/Alcohol Dependence (HCC 55) with a community, non-dual, aged base RAF weight of 0.334. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Document the specific type of sexual dysfunction when available (erectile dysfunction, decreased libido, etc.). Because F11.181 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for F11.181 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific type of sexual dysfunction when available (erectile dysfunction, decreased libido, etc.)
- •Ensure the sexual dysfunction is attributed to opioid abuse and not another underlying condition
Clinical Significance
Opioid abuse with opioid-induced sexual dysfunction captures sexual performance or desire problems directly caused by opioid misuse, including erectile dysfunction, decreased libido, and delayed orgasm. Opioids suppress gonadotropin-releasing hormone, leading to hypogonadism and related sexual dysfunction. This is a quality-of-life issue that may also affect treatment adherence.
Documentation Requirements
- ✓Provider documentation of opioid abuse
- ✓Documentation of specific sexual dysfunction (erectile dysfunction, decreased libido, anorgasmia, delayed ejaculation)
- ✓Statement attributing sexual dysfunction to opioid use
- ✓Assessment ruling out other causes (vascular disease, hormonal disorders, medications, psychological factors)
- ✓Hormone levels if tested (testosterone may be low due to opioid-induced hypogonadism)