Is ICD-10-CM code F11 billable?

No, F11 (Opioid related disorders) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code F11 belong to?

F11 belongs to Chapter 5 of the ICD-10-CM tabular list: F01–F99 (Mental, Behavioral and Neurodevelopmental Disorders).

F11Not billable, use a more specific code below

Opioid related disorders

In Mental and behavioral disorders due to psychoactive substance use (F10-F19), chapter 5: Mental, Behavioral and Neurodevelopmental Disorders

45 billable codes under F11: 18 are a CC; 43 map to HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications), HCC 135 (Drug Use with Psychotic Complications), HCC 138 (Drug Use Disorder, Mild, Uncomplicated, Except Cannabis).A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment. An HCC counts toward a Medicare Advantage patient's risk score.

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Section I.C.5.b Mental and behavioral disorders due to psychoactive substance use (page 43), covers F11
Code only one pattern per substance: dependence outranks abuse and use, and abuse outranks use. Remission and unspecified use codes need provider documentation; code medical conditions separately with the substance code.

All codes under F11

F11 can't be used on a claim. Pick a billable code below; grey headings group them.

F11 MS-DRGs

As the principal diagnosis, the billable codes under F11 group to MS-DRG 894, 895, 896, 897, 791, or 793 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 894 Alcohol, Drug Abuse or Dependence, Left AMA (45 of 45 codes)
DRG 895 Alcohol, Drug Abuse or Dependence with Rehabilitation Therapy (45 of 45 codes)
DRG 896 Alcohol, Drug Abuse or Dependence without Rehabilitation Therapy with MCC (45 of 45 codes)
DRG 897 Alcohol, Drug Abuse or Dependence without Rehabilitation Therapy without MCC (45 of 45 codes)
DRG 791 Prematurity with Major Problems (3 of 45 codes)
DRG 793 Full Term Neonate with Major Problems (3 of 45 codes)

Other codes that refer to F11

Notes on these codes point to F11.

F20 Excludes2: psychoactive drug use (F11-F19 with .15. .25, .95)
K85.3 Use Additional Code: code to identify drug abuse and dependence (F11.-F17.-)
O99.32 Use Additional Code: code(s) from F11-F16 and F18-F19 to identify manifestations of the drug use
R44 Excludes1: hallucinations in drug psychosis (F11-F19 with fifth to sixth characters 51)
Z71.5 Use Additional Code: code for drug abuse or dependence (F11-F16, F18-F19)
Z79 Excludes2: drug abuse and dependence (F11-F19)
Z81.3 Includes: Conditions classifiable to F11-F16, F18-F19

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Opioids and Opioid Use Disorder (OUD)

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid. Some opioids are made from the opium plant, and others are synthetic (man-made).

Prescription Drug Misuse

If you take a medicine in a different way than your health care provider prescribed, it's called prescription drug misuse. It could be: Misusing some prescription drugs can lead to addiction. These include opioids, sedatives, tranquilizers, and stimulants. Drug addiction is a chronic brain disease. It causes a person to take drugs repeatedly despite the harm they cause.

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.