F11.988 ICD-10-CM Code: Opioid use, unspecified with other opioid-induced disorder
F11.988 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. 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)
F11.988
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOpioid use, unspecified with other opioid-induced disorder
This code describes a patient who uses opioids (such as heroin, prescription painkillers, or other opioid substances) in an unspecified pattern and has developed a medical condition caused by the opioid use that is not classified elsewhere. Examples include opioid-induced sleep disorders or other complications from opioid use.
Buddy Insight
This code captures other specified opioid-induced disorders that do not fit into the more specific categories like psychosis, sexual dysfunction, or sleep disorder.
CMS-HCC V28
MappedHCC 137
Coefficient HCC 137: 0.424 (Community Non-Dual Aged (CNA))
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
Official- Opioid-associated amnestic syndrome without use disorder
- Opioid induced anxiety disorder, without use disorder
Excludes 2
Official- symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99
Related Codes
Includes
Official- disorders of psychological developmentInherited from F01-F99
Excludes 1
Official- opioid abuse (F11.1-)Inherited from F11.9
- opioid dependence (F11.2-)Inherited from F11.9
Code First
OfficialNo Code First sequencing instructions are included in this display for F11.988. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F11.988. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F11.988. Check the code and parent instructions in the Code Book.
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 F11.988 an HCC code?
Yes. F11.988 (Opioid use, unspecified with other 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: F11.988 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
- F11.988
- Description
- Opioid use, unspecified with other 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 F11.988 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F11.988
For F11.988, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
F11.988 is the ICD-10-CM diagnosis code for opioid use, unspecified with other opioid-induced disorder. This code describes a patient who uses opioids (such as heroin, prescription painkillers, or other opioid substances) in an unspecified pattern and has developed a medical condition caused by the opioid use that is not classified elsewhere. Examples include opioid-induced sleep disorders or other complications from opioid use. F11.988 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, F11.988 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. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. 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.
Use this code only when the specific pattern of opioid use (occasional, continuous, or in remission) cannot be determined from the medical record. For F11.988, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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 F11.988 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the specific pattern of opioid use (occasional, continuous, or in remission) cannot be determined from the medical record
- •The 'other opioid-induced disorder' portion indicates a complication from opioid use; if a more specific opioid-related condition is documented (such as opioid-induced depression or anxiety), use the more specific code instead
Clinical Significance
This code captures other specified opioid-induced disorders that do not fit into the more specific categories like psychosis, sexual dysfunction, or sleep disorder. Examples include opioid-induced hyperalgesia, opioid-induced constipation of clinical significance, or opioid-induced endocrinopathy. Documenting these conditions demonstrates the full clinical complexity of opioid use and supports appropriate risk adjustment.
Documentation Requirements
- ✓Documentation of opioid use (substance and pattern if known)
- ✓Specific description of the opioid-induced disorder (not psychosis, sexual dysfunction, or sleep disorder)
- ✓Causal relationship statement linking the disorder to opioid use
- ✓Clinical findings supporting the induced disorder diagnosis
- ✓Exclusion of other potential causes for the induced disorder
Commonly Confused Codes
- •F11.982: Opioid use, unspecified with opioid-induced sleep disorder; use when the specific disorder is a sleep disturbance
- •F11.981: Opioid use, unspecified with opioid-induced sexual dysfunction; use for sexual dysfunction specifically
- •F11.99: Opioid use, unspecified with unspecified opioid-induced disorder; use only when the specific type of induced disorder is not documented at all
- •F11.288: Opioid dependence with other opioid-induced disorder; use when dependence is documented