F11.19 ICD-10-CM Code: Opioid abuse with unspecified opioid-induced disorder
F11.19 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)
F11.19
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOpioid abuse with unspecified opioid-induced disorder
A person who misuses opioids and has some opioid-related health problem, but the specific problem is not identified or documented.
Buddy Insight
Opioid abuse with unspecified opioid-induced disorder is the least specific code for opioid abuse with an induced condition.
CMS-HCC V28
MappedHCC 137
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 082
Code-level coefficient reference
ESRD/PACE
MappedHCC 55
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for F11.19 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for F11.19 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for F11.19 in this effective period.
Excludes 1
Official- opioid dependence (F11.2-)
- opioid use, unspecified (F11.9-)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for F11.19 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for F11.19 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for F11.19 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 F11.19 an HCC code?
Yes. F11.19 (Opioid abuse with unspecified opioid-induced disorder) maps to HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.424. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: F11.19 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
- F11.19
- Description
- Opioid abuse with unspecified opioid-induced disorder
- HCC (V28)
- HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
- RAF reference coefficient
- 0.424
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work F11.19 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT Criteria for F11.19
For F11.19 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 F11.19 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
F11.19 is the ICD-10-CM diagnosis code for opioid abuse with unspecified opioid-induced disorder. A person who misuses opioids and has some opioid-related health problem, but the specific problem is not identified or documented. F11.19 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, F11.19 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a source-labeled community, non-dual, aged reference coefficient of 0.424. No V24 mapping is shown for F11.19; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
This is a residual code; use only when the specific opioid-induced disorder cannot be determined. Because F11.19 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, and MEAT documentation criteria for F11.19 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a residual code; use only when the specific opioid-induced disorder cannot be determined
- •Query the provider to identify the specific induced disorder for more accurate coding when possible
Clinical Significance
Opioid abuse with unspecified opioid-induced disorder is the least specific code for opioid abuse with an induced condition. It indicates an opioid-related health problem exists in the context of abuse but the specific disorder is not documented. This code should trigger a provider query for more specific documentation.
Documentation Requirements
- ✓Provider documentation of opioid abuse
- ✓Documentation that an opioid-induced disorder is present but not further specified
- ✓Assessment of the patient's opioid use pattern
- ✓Evidence supporting query to the provider for specificity
Commonly Confused Codes
- •F11.10: Opioid abuse, uncomplicated: use when NO induced disorder is present
- •F11.188: Opioid abuse with other opioid-induced disorder: use when the disorder is identified but lacks a specific code
- •F11.14: Opioid abuse with opioid-induced mood disorder: use when mood disorder is documented
- •F11.99: Opioid use, unspecified with unspecified opioid-induced disorder: use when the use pattern is also unspecified