F11.259 — Opioid dependence with opioid-induced psychotic disorder, unspecified
F11.259 is a billable, specific ICD-10-CM code for opioid dependence with opioid-induced psychotic disorder, unspecified. It is valid for submission on a claim.
Risk adjustment
F11.259 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 135 Drug Use with 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.
Medicare coverage
F11.259 is named in 20 Medicare coverage policies — 18 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
- A56562Billing and Coding: Health and Behavior Assessment/Interventionnot covered
- A54799Billing and Coding: Urine Drug Testing
- A55001Billing and Coding: Urine Drug Testing
How F11.259 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to F11.259.
- Dependence›drug NEC›opioid›with›psychosis
Related codes at this level
Codes that share F11.25. If F11.259 is not quite right, the correct code is usually one of these.
Questions about F11.259
- Is F11.259 a billable ICD-10-CM code?
- Yes. F11.259 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does F11.259 sit in the tabular list?
- Mental, Behavioral and Neurodevelopmental disorders (F01-F99), in the block Mental and behavioral disorders due to psychoactive substance use (F10-F19).