What is ICD-10 code F11.988?

F11.988 is the ICD-10-CM diagnosis code for Opioid use, unspecified with other opioid-induced disorder. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F11.988 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F11.988 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F11.988 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F11.988 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for F11.988?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For F11.988, V28 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe at RAF 0.358 while V24 mapped to Drug/Alcohol Dependence at RAF 0.334. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting F11.988?

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 Because F11.988 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

F11.988 ICD-10 Code: Opioid use, unspecified

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupF11.988Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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 guidance

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.

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

Mapped

HCC 137

Drug Use Disorder/Substance U...

RAF 0.358

CMS-HCC V24

Mapped

HCC 55

Drug/Alcohol Dependence

RAF 0.334

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 55

Drug/Alcohol Dependence

RAF 0.0

RXHCC

Not risk-adjusted for this model/period.

RAF 0

Code Trumping

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Code Book Path

Official

F11.9Opioid use, unspecified

F11.98Opioid use, unspecified with other specified opioid-induced disorder

F11.988Opioid use, unspecified with other opioid-induced disorder

Inclusion Terms

Official

Opioid-associated amnestic syndrome without use disorder
Opioid induced anxiety disorder, without use disorder

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F11.988 in this effective period.

Related Child Codes

Official

F11.981Opioid use, unspecified with opioid-induced sexual dysfunction

F11.982Opioid use, unspecified with opioid-induced sleep disorder

Includes

Official

ICD-10-CM does not list Includes notes for F11.988 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F11.988 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F11.988 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F11.988 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F11.988 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Defaulting to this code without first checking if a more specific opioid-induced disorder code exists

Using this code when the documentation is too vague to identify any specific induced disorder — in that case F11.99 is more appropriate

Assigning this code when the pattern of use is clearly abuse or dependence rather than unspecified

Failing to document what the 'other' opioid-induced disorder actually is in clinical notes

Common Mistakes

HCC Buddy guidance

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

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is F11.988 an HCC code?

Yes. F11.988 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Dependence under V24).

HCC Category Mapping

V28HCC 137, Drug Use Disorder/Substance Use Disorder, Moderate/Severe

0.358

V24HCC 55, Drug/Alcohol Dependence

0.334

ESRDHCC 55, Drug/Alcohol Dependence

0.000

RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

MEAT Criteria for F11.988

For F11.988to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

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

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed F11.988 during that encounter, not just copy-forwarded from a problem list.

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/Substance Use Disorder, Moderate/Severe (HCC 137) with a community, non-dual, aged base RAF weight of 0.358. Under the older CMS-HCC V24 model, F11.988 maps to Drug/Alcohol Dependence (HCC 55) with a community, non-dual, aged base RAF weight of 0.334. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

Use this code only when the specific pattern of opioid use (occasional, continuous, or in remission) cannot be determined from the medical record. Because F11.988 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, 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