F11.23
BillableOpioid dependence with withdrawal
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
This code describes a patient who is dependent on opioids and is currently experiencing withdrawal symptoms, which occur when opioid use is reduced or stopped. Withdrawal can cause physical discomfort and psychological symptoms like anxiety, pain, and cravings.
Coding Tips
- •Ensure documentation clearly indicates both the opioid dependence AND the active withdrawal state; withdrawal alone without documented dependence would use a different code
- •Specify the type of opioid if documented (heroin, prescription opioids, synthetic opioids) as this may affect treatment planning and should be reflected in more specific coding when available
Clinical Significance
Opioid dependence with withdrawal is a critical diagnosis indicating a physiologically dependent patient experiencing withdrawal symptoms upon cessation or reduction of opioid use. Opioid withdrawal causes intense physical and psychological distress and is a major driver of relapse and continued use. This code captures a high-acuity clinical state requiring active medical management.
Documentation Requirements
- ✓Provider documentation of opioid dependence
- ✓Documentation of active withdrawal symptoms (myalgia, lacrimation, rhinorrhea, diaphoresis, piloerection, nausea, vomiting, diarrhea, insomnia, anxiety, restlessness)
- ✓Clinical Opiate Withdrawal Scale (COWS) score if available
- ✓Temporal relationship between opioid cessation/reduction and symptom onset
- ✓Type of opioid if documented
- ✓Withdrawal management plan (medication-assisted treatment, supportive care)
- ✓Assessment for medication-assisted treatment candidacy
Excludes 1 — Do NOT code together
- opioid dependence with intoxication (F11.22-)
Commonly Confused Codes
F11.13 — Opioid abuse with withdrawal: use when abuse (not dependence) is the documented patternF11.93 — Opioid use, unspecified with withdrawal: use when the use pattern is unspecifiedF11.20 — Opioid dependence, uncomplicated: use when no active withdrawal is presentF11.220 — Opioid dependence with intoxication: withdrawal and intoxication are mutually exclusive states
Code Hierarchy
└F11Opioid related disorders└F11.2Opioid dependence└F11.23Opioid dependence with withdrawal
└F11.23Opioid dependence with withdrawal