F11.20
BillableOpioid dependence, uncomplicated
HCC Category Mapping
V28HCC 137 — Drug Use Disorder/Substance Use Disorder, Moderate/Severe
0.358V24HCC 55 — Drug/Alcohol Dependence
0.334ESRDHCC 55 — Drug/Alcohol Dependence
0.000What This Code Means
A person who is dependent on opioids (unable to stop using despite wanting to) and has no current complications from the dependence.
Coding Tips
- •This code indicates opioid dependence without acute intoxication, withdrawal, or other specified complications
- •Document whether the patient is in treatment or attempting to manage the dependence
Clinical Significance
Opioid dependence, uncomplicated is a critical diagnosis indicating physiological and psychological addiction to opioids with tolerance and withdrawal potential, but without current active complications. This diagnosis captures a chronic condition requiring ongoing management, often including medication-assisted treatment, and reflects significant expected healthcare utilization.
Documentation Requirements
- ✓Provider documentation explicitly stating opioid dependence (not just abuse or use)
- ✓Evidence of dependence criteria: tolerance, withdrawal potential, compulsive use, continued use despite harm
- ✓Type of opioid if documented (heroin, prescription opioids, fentanyl)
- ✓Current treatment status (medication-assisted treatment: methadone, buprenorphine, naltrexone)
- ✓Confirmation that no current complications (intoxication, withdrawal, induced disorders) are present
- ✓Treatment and monitoring plan
Commonly Confused Codes
F11.10 — Opioid abuse, uncomplicated: use when abuse (not dependence) criteria are metF11.21 — Opioid dependence, in remission: use when the patient is in documented remissionF11.90 — Opioid use, unspecified, uncomplicated: use when the pattern cannot be classified as abuse or dependenceF11.23 — Opioid dependence with withdrawal: use when active withdrawal symptoms are present
Code Hierarchy
└F11Opioid related disorders└F11.2Opioid dependence└F11.20Opioid dependence, uncomplicated
└F11.20Opioid dependence, uncomplicated