F11.259
BillableOpioid dependence with opioid-induced psychotic disorder, unspecified
HCC Category Mapping
V28HCC 135 — Drug/Alcohol Psychosis
0.000V24HCC 54 — Drug/Alcohol Psychosis
0.434ESRDHCC 54 — Drug/Alcohol Psychosis
0.000What This Code Means
A person is dependent on opioids and experiences psychotic symptoms caused by opioid use, but the specific type of psychotic symptoms is not documented.
Coding Tips
- •Use this code only when psychotic disorder is present but the specific manifestation (delusions vs. hallucinations) is not documented
- •Encourage documentation of the specific psychotic features for more accurate coding
Clinical Significance
Opioid dependence with opioid-induced psychotic disorder, unspecified captures opioid-induced psychosis in a dependent patient where the specific type (delusions vs. hallucinations) is not documented. While still capturing HCC 54 in V24, this unspecified code should prompt provider query for better specificity.
Documentation Requirements
- ✓Provider documentation of opioid dependence
- ✓Statement that psychotic symptoms are opioid-induced
- ✓Documentation that psychosis is present but specific type is not documented
- ✓Mental status examination supporting psychotic features
- ✓Assessment ruling out primary psychotic disorders
Commonly Confused Codes
F11.250 — Opioid dependence with psychotic disorder with delusions: use when delusions are specifiedF11.251 — Opioid dependence with psychotic disorder with hallucinations: use when hallucinations are specifiedF11.159 — Opioid abuse with psychotic disorder, unspecified: use when abuse (not dependence) is documentedF29 — Unspecified psychosis not due to a substance: use when psychosis is NOT substance-induced
Code Hierarchy
└F11Opioid related disorders└F11.2Opioid dependence└F11.25Opioid dependence with opioid-induced psychotic disorder└F11.259Opioid dependence with opioid-induced psychotic disorder, unspecified
└F11.259Opioid dependence with opioid-induced psychotic disorder, unspecified