F19.11
BillableOther psychoactive substance abuse, in remission
HCC Category Mapping
V28HCC 138 — Drug Use Disorder/Substance Use Disorder, Mild
0.476V24HCC 56 — Drug/Alcohol Abuse, Without Dependence
0.000ESRDHCC 56 — Drug/Alcohol Abuse, Without Dependence
0.000What This Code Means
A person who previously abused various psychoactive substances but is now in remission and no longer actively using.
Coding Tips
- •Document the length of remission (early or sustained) when available
- •Ensure clinical documentation supports remission status before coding
Clinical Significance
This code captures other psychoactive substance abuse in remission, indicating a history of substance use disorder with current recovery status. Even in remission, these patients require ongoing monitoring, relapse prevention support, and continued behavioral health engagement. Accurate coding ensures appropriate risk adjustment reflecting the chronic nature of substance use disorders and ongoing care needs.
Documentation Requirements
- ✓Provider documentation specifying the psychoactive substance(s) involved (e.g., designer drugs, bath salts, kratom, polysubstance use)
- ✓Clinical documentation supporting substance abuse pattern (maladaptive use pattern causing clinically significant impairment) without meeting criteria for dependence
- ✓Provider documentation confirming remission status with notation of duration (early remission: 3-12 months; sustained remission: 12+ months)
- ✓Evidence of ongoing recovery efforts such as counseling, support group participation, or medication-assisted treatment
- ✓Assessment and plan addressing the substance use disorder with treatment approach documented
Commonly Confused Codes
F19.20-F19.29 (Other psychoactive substance dependence) — dependence indicates a more severe pattern with tolerance, compulsive use, or withdrawal; abuse is a less severe use patternF19.90-F19.99 (Other psychoactive substance use, unspecified) — unspecified use is used when abuse vs. dependence is not documentedF19.10 (Uncomplicated, active) — uncomplicated indicates active use disorder without current complications; remission indicates the patient is no longer actively usingF10-F16 (Specific substance codes: alcohol, opioids, cannabis, sedatives, cocaine, stimulants) — use substance-specific codes when the substance is identified; F19 is for 'other' or multiple unspecified substances
Code Hierarchy
└F19Other psychoactive substance related disorders└F19.1Other psychoactive substance abuse└F19.11Other psychoactive substance abuse, in remission
└F19.11Other psychoactive substance abuse, in remission