F11.23

F11.23: Opioid dependence with withdrawal

Billable / specific codeICD-10-CM

F11.23 is a billable, specific ICD-10-CM code for opioid dependence with withdrawal. It is valid for submission on a claim.

Check F11.23 with the rest of the claim: free scrubber

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

opioid dependence with intoxication (F11.22-)

Excludes1 inherited from the categories above F11.23

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 F11.23

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-)

Other codes that can never be billed with F11.23

Their own Excludes1 notes name this code, so the conflict is not listed above.

F11.22Opioid dependence with intoxication

Risk adjustment

F11.23 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

F11.23 is named in 26 Medicare coverage policies: 25 listing it as supporting medical necessity, and 1 listing it as NOT covered. Which one applies depends on your Medicare contractor.

A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
A54799Billing and Coding: Urine Drug Testing
A55001Billing and Coding: Urine Drug Testing
A56614Billing and Coding: Psychiatric Inpatient Hospitalization