F11.959

HCC Category Mapping

What This Code Means

Psychotic symptoms caused by opioid use when the specific type of psychotic symptom is not clearly documented or specified.

Coding Tips

• •Use only when documentation does not specify delusions or hallucinations
• •Review records to determine if F11.950 or F11.951 would be more appropriate

Clinical Significance

Opioid-induced psychotic disorder represents a severe psychiatric complication of opioid use that requires urgent intervention and indicates high clinical complexity. This diagnosis is significant for risk adjustment because it captures the intersection of substance use and psychosis, reflecting increased healthcare utilization and the need for both psychiatric and addiction treatment services. Accurate capture ensures appropriate resource allocation for these medically complex patients.

Documentation Requirements

• ✓Documentation of opioid use (specific opioid substance if known)
• ✓Description of psychotic symptoms (hallucinations, delusions, or unspecified)
• ✓Temporal relationship between opioid use and onset of psychotic symptoms
• ✓Statement that psychotic disorder is induced by opioid use, not a primary psychotic disorder
• ✓Current pattern of opioid use (use, abuse, or dependence) — if determinable
• ✓Mental status examination findings supporting psychosis

Commonly Confused Codes