What is ICD-10 code F11.188?

F11.188 is the ICD-10-CM diagnosis code for Opioid abuse with other opioid-induced disorder. A person who misuses opioids and experiences other medical or mental health problems caused by the opioid use that are not covered by more specific codes. F11.188 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F11.188 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F11.188 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F11.188 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What should coders know when reporting F11.188?

Document the specific opioid-induced disorder in the medical record (e.g., anxiety, mood disorder, cognitive impairment) Use this code only when the induced disorder doesn't fit into other specified F11.1x categories Because F11.188 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM F11.188: Opioid abuse with other

ICD-10-CM Code View

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Code lookupF11.188Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)

F11.188

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Opioid abuse with other opioid-induced disorder

A person who misuses opioids and experiences other medical or mental health problems caused by the opioid use that are not covered by more specific codes.

Buddy Insight

CMS-HCC V28

Mapped

HCC 137

Drug Use Disorder, Moderate/S...

RAF 0.424

CMS-HCC V24

Mapped

HCC 55

Substance Use Disorder, Moder...

RAF 0.329

ACA/HHS

Mapped

HCC 82

HHS-HCC 82

Varies by metal level

ESRD/PACE

Mapped

HCC 55

Substance Use Disorder, Moder...

RAF 0.111

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F11.1Opioid abuse

F11.18Opioid abuse with other opioid-induced disorder

F11.188Opioid abuse with other opioid-induced disorder

Inclusion Terms

Official

Opioid-associated amnestic syndrome with opioid abuse

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F11.188 in this effective period.

Related Child Codes

Official

F11.181Opioid abuse with opioid-induced sexual dysfunction

F11.182Opioid abuse with opioid-induced sleep disorder

Includes

Official

ICD-10-CM does not list Includes notes for F11.188 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F11.188 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F11.188 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F11.188 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F11.188 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Provider documentation of opioid abuse

Documentation of the specific opioid-induced disorder (anxiety, cognitive impairment, etc.)

Statement that the condition is opioid-induced

Assessment ruling out other etiologies

MEAT Support

HCC Buddy guidance

Provider documentation of opioid abuse

Documentation of the specific opioid-induced disorder (anxiety, cognitive impairment, etc.)

Statement that the condition is opioid-induced

Assessment ruling out other etiologies

Audit Caution

HCC Buddy guidance

Using this 'other specified' code when a more specific code exists

Confusing 'other' (identified but no specific code) with 'unspecified' (not identified)

Not documenting what the 'other' induced disorder is in the record

Using the dependence code when abuse is documented

Common Mistakes

HCC Buddy guidance

F11.14 — Opioid abuse with opioid-induced mood disorder: use when mood disorder is the specific induced condition

F11.181 — Opioid abuse with opioid-induced sexual dysfunction: use when sexual dysfunction is present

F11.182 — Opioid abuse with opioid-induced sleep disorder: use when sleep disorder is present

F11.19 — Opioid abuse with unspecified opioid-induced disorder: use when the induced disorder is not identified at all

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is F11.188 an HCC code?

Yes. F11.188 (Opioid abuse with other opioid-induced disorder) maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications under the CMS-HCC V28 risk adjustment model (and Substance Use Disorder, Moderate/Severe, or Substance Use with Complications under V24), with a community non-dual aged RAF of 0.424. It is billable for payment year 2026.

Coder answer: F11.188 is billable and maps to V28 HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F11.188
Description: Opioid abuse with other opioid-induced disorder
HCC (V28): HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
RAF: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications

0.424

V24HCC 55, Substance Use Disorder, Moderate/Severe, or Substance Use with Complications

0.329

ESRDHCC 55, Substance Use Disorder, Moderate/Severe, or Substance Use with Complications

0.111

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.

Work F11.188 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for F11.188

For F11.188 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 F11.188 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F11.188 is the ICD-10-CM diagnosis code for opioid abuse with other opioid-induced disorder. A person who misuses opioids and experiences other medical or mental health problems caused by the opioid use that are not covered by more specific codes. F11.188 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, F11.188 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a community, non-dual, aged base RAF weight of 0.424. Under the older CMS-HCC V24 model, F11.188 maps to Substance Use Disorder, Moderate/Severe, or Substance Use with Complications (HCC 55) with a community, non-dual, aged base RAF weight of 0.329. 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 opioid-induced disorder in the medical record (e.g., anxiety, mood disorder, cognitive impairment). Because F11.188 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 F11.188 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document the specific opioid-induced disorder in the medical record (e.g., anxiety, mood disorder, cognitive impairment)
•Use this code only when the induced disorder doesn't fit into other specified F11.1x categories

Clinical Significance

Opioid abuse with other opioid-induced disorder captures opioid-induced conditions not classified under specific codes, such as opioid-induced anxiety disorder, cognitive impairment, or other neuropsychiatric effects. This code serves as a catch-all for documented opioid-induced conditions that lack their own specific code within the abuse category.

Documentation Requirements

✓Provider documentation of opioid abuse
✓Documentation of the specific opioid-induced disorder (anxiety, cognitive impairment, etc.)
✓Statement that the condition is opioid-induced
✓Assessment ruling out other etiologies
✓Explanation of why a more specific F11.1x code does not apply

Commonly Confused Codes

•F11.14: Opioid abuse with opioid-induced mood disorder: use when mood disorder is the specific induced condition
•F11.181: Opioid abuse with opioid-induced sexual dysfunction: use when sexual dysfunction is present
•F11.182: Opioid abuse with opioid-induced sleep disorder: use when sleep disorder is present
•F11.19: Opioid abuse with unspecified opioid-induced disorder: use when the induced disorder is not identified at all