F11.21

F11.21: Opioid dependence, in remission

Billable / specific codeICD-10-CM

F11.21 is a billable, specific ICD-10-CM code for opioid dependence, in remission. It is valid for submission on a claim.

Check F11.21 with the rest of the claim: free scrubber

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Opioid use disorder, moderate, in early remission
Opioid use disorder, moderate, in sustained remission
Opioid use disorder, severe, in early remission
Opioid use disorder, severe, in sustained remission

Excludes1 inherited from the categories above F11.21

A category’s note binds every code beneath it.

Written on F11.2: Opioid dependence

opioid abuse (F11.1-)
opioid use, unspecified (F11.9-)

Excludes2 inherited from the categories above F11.21

Not part of this code, but both may be coded when both are present.

Written on F11.2: Opioid dependence

opioid poisoning (T40.0-T40.2-)

Risk adjustment

F11.21 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 137 Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications0.424 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

F11.21 is named in 13 Medicare coverage policies: 11 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which one applies depends on your Medicare contractor.

A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
A56865Billing and Coding: Psychiatric Inpatient Hospitalizationnot covered
A56645Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
A56818Billing and Coding: Urine Drug Testing