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F11.10 ICD-10-CM Code: Opioid abuse, uncomplicated

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 inclusion term · 2 Excludes1
Risk adjustment
CMS-HCC V28: 1 category

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 894 — ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA (MDC 20)
  • MS-DRG 895 — ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY (MDC 20)
  • MS-DRG 896 — ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC (MDC 20)
  • MS-DRG 897 — ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC (MDC 20)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 138 — Drug Use Disorder, Mild, Uncomplicated, Except Cannabis (supersedes HCC 139)

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for F11.10 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on F11.10 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Opioid use disorder, mild

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from F11.1

Coder workflow for F11.10

MedCoder structured workflow — derived from this code’s own official record

Before you code F11.10

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with F11.10. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in F11.10’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewF11.2, F11.9

Consider F11.10. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).

Official instructions as workflow

  • Excludes1 — check before selecting F11.10(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with F11.10: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareF11.2, F11.9

    See the official tabular notes · Guidelines I.A.12.a

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition F11.10 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewF11.2, F11.9

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Opioid abuse, uncomplicated is a billable ICD-10-CM diagnosis code (F11.10).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (2)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A)

3) Drug use during pregnancy, childbirth and the puerperium Codes under subcategory O99.32, Drug use complicating pregnancy, childbirth, and the puerperium, should be assigned for any pregnancy case when a patient uses drugs during the pregnancy or postpartum. This can involve illegal drugs, or inappropriate use or abuse of prescription drugs. Secondary code(s) from categories F11-F16 and F18-F19 should also be assigned to identify manifestations of the drug use.

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name F11.10 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 4 Excludes1 notes across 2 chapters: F11.2 — Opioid dependence (via F11.1.-), F11.9 — Opioid use, unspecified (via F11.1.-), R41.3 — Other amnesia (via F11.-), R44 — Other symptoms and signs involving general sensations and perceptions (via F11.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 33 Excludes2 notes across 4 chapters: F02 — Dementia in other diseases classified elsewhere (via F11.-), F06 — Other mental disorders due to known physiological condition (via F11.-), F06.0 — Psychotic disorder with hallucinations due to known physiological condition (via F11.-), F06.2 — Psychotic disorder with delusions due to known physiological condition (via F11.-), F06.3 — Mood disorder due to known physiological condition (via F11.-), F06.4 — Anxiety disorder due to known physiological condition (via F11.-), F20 — Schizophrenia (via F11.-), F55 — Abuse of non-psychoactive substances (via F11.-), F63 — Impulse disorders (via F11.-), F63.1 — Pyromania (via F11.-), R78 — Findings of drugs and other substances, not normally found in blood (via F11.-), T36 — Poisoning by, adverse effect of and underdosing of systemic antibiotics (via F11.-), T36-T39 — Antibiotics & Anti-infectives (T36-T39) (via F11.-), T36-T50 — Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances (T36-T50) (via F11.-), T37 — Poisoning by, adverse effect of and underdosing of other systemic anti-infectives and antiparasitics (via F11.-), T38 — Poisoning by, adverse effect of and underdosing of hormones and their synthetic substitutes and antagonists, not elsewhere classified (via F11.-), T39 — Poisoning by, adverse effect of and underdosing of nonopioid analgesics, antipyretics and antirheumatics (via F11.-), T40 — Poisoning by, adverse effect of and underdosing of narcotics and psychodysleptics [hallucinogens] (via F11.-), T40-T41 — Analgesics & Antipyretics (T40-T41) (via F11.-), T41 — Poisoning by, adverse effect of and underdosing of anesthetics and therapeutic gases (via F11.-), +13 more.

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 3 Use Additional Code instructions across 3 chapters: K85.3 — Drug induced acute pancreatitis (via F11.-), O99.32 — Drug use complicating pregnancy, childbirth, and the puerperium (via F11.-), Z71.5 — Drug abuse counseling and surveillance (via F11.-).

These codes instruct coders to additionally report this code when it applies.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 4 MS-DRGs: DRG 894 (MDC 20), DRG 895 (MDC 20), DRG 896 (MDC 20), DRG 897 (MDC 20).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):MBD018 — Opioid-related disorders (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Drug Use Disorder, Mild, Uncomplicated, Except Cannabis) for risk-adjusted payment.

F11.11 — Opioid abuse, in remission, F13.10 — Sedative, hypnotic or anxiolytic abuse, uncomplicated, F13.11 — Sedative, hypnotic or anxiolytic abuse, in remission, F14.10 — Cocaine abuse, uncomplicated, F14.11 — Cocaine abuse, in remission, F15.10 — Other stimulant abuse, uncomplicated, F15.11 — Other stimulant abuse, in remission, F16.10 — Hallucinogen abuse, uncomplicated, F16.11 — Hallucinogen abuse, in remission, F18.10 — Inhalant abuse, uncomplicated, F18.11 — Inhalant abuse, in remission, F19.10 — Other psychoactive substance abuse, uncomplicated, F19.11 — Other psychoactive substance abuse, in remission

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Drug Use with Psychotic Complications, Alcohol Use with Psychotic Complications, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications, Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Opioid-related disorders).

F11.120 — Opioid abuse with intoxication, uncomplicated, F11.121 — Opioid abuse with intoxication delirium, F11.122 — Opioid abuse with intoxication with perceptual disturbance, F11.129 — Opioid abuse with intoxication, unspecified, F11.13 — Opioid abuse with withdrawal, F11.14 — Opioid abuse with opioid-induced mood disorder, F11.150 — Opioid abuse with opioid-induced psychotic disorder with delusions, F11.151 — Opioid abuse with opioid-induced psychotic disorder with hallucinations, F11.159 — Opioid abuse with opioid-induced psychotic disorder, unspecified, F11.181 — Opioid abuse with opioid-induced sexual dysfunction, F11.182 — Opioid abuse with opioid-induced sleep disorder, F11.188 — Opioid abuse with other opioid-induced disorder, F11.19 — Opioid abuse with unspecified opioid-induced disorder, F11.20 — Opioid dependence, uncomplicated, F11.220 — Opioid dependence with intoxication, uncomplicated, F11.221 — Opioid dependence with intoxication delirium, F11.222 — Opioid dependence with intoxication with perceptual disturbance, F11.229 — Opioid dependence with intoxication, unspecified, F11.23 — Opioid dependence with withdrawal, F11.24 — Opioid dependence with opioid-induced mood disorder, +64 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Abuse”; these codes share that main term but sit in a different category of the Tabular List.

F10.139 — Alcohol abuse with withdrawal, unspecified (alcohol, with, withdrawal), F10.14 — Alcohol abuse with alcohol-induced mood disorder (alcohol, with, mood disorder), F10.150 — Alcohol abuse with alcohol-induced psychotic disorder with delusions (alcohol, with, psychosis, delusions), F10.151 — Alcohol abuse with alcohol-induced psychotic disorder with hallucinations (alcohol, with, psychosis, hallucinations), F10.159 — Alcohol abuse with alcohol-induced psychotic disorder, unspecified (alcohol, with, psychosis), F10.180 — Alcohol abuse with alcohol-induced anxiety disorder (alcohol, with, anxiety disorder), F10.181 — Alcohol abuse with alcohol-induced sexual dysfunction (alcohol, with, sexual dysfunction), F10.182 — Alcohol abuse with alcohol-induced sleep disorder (alcohol, with, sleep disorder), F10.188 — Alcohol abuse with other alcohol-induced disorder (alcohol, with, other specified disorder), F10.19 — Alcohol abuse with unspecified alcohol-induced disorder (alcohol, with, unspecified disorder), F12.10 — Cannabis abuse, uncomplicated (drug NEC, cannabis), F12.11 — Cannabis abuse, in remission (drug NEC, cannabis, in remission), F12.120 — Cannabis abuse with intoxication, uncomplicated (drug NEC, cannabis, with, intoxication, uncomplicated), F12.121 — Cannabis abuse with intoxication delirium (drug NEC, cannabis, with, intoxication, with, delirium), F12.122 — Cannabis abuse with intoxication with perceptual disturbance (drug NEC, cannabis, with, intoxication, with, perceptual disturbance), F12.129 — Cannabis abuse with intoxication, unspecified (drug NEC, cannabis, with, intoxication), F12.13 — Cannabis abuse with withdrawal (drug NEC, cannabis, with, withdrawal), F12.150 — Cannabis abuse with psychotic disorder with delusions (drug NEC, cannabis, with, psychosis, delusions), F12.151 — Cannabis abuse with psychotic disorder with hallucinations (drug NEC, cannabis, with, psychosis, hallucinations), F12.159 — Cannabis abuse with psychotic disorder, unspecified (drug NEC, cannabis, with, psychosis), +118 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Gamma-glutamyl Transferase (GGT) Test

Contextual Map

Every relationship of F11.10 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run F11.10 with these 15 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes (33)

Referenced by Use Additional Code instructions

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 138 — Drug Use Disorder, Mild, Uncomplicated, Except Cannabis [CMS-HCC]: “Drug Use Disorder, Mild, Uncomplicated, Except Cannabis — supersedes HCC 139 (Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications)”— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

  • MDC 20 — Alcohol or Drug Use or Induced Organic Mental Disorders[MDC crossing]: “Alcohol or Drug Use or Induced Organic Mental Disorders — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 35 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Abuse, drug NEC (non-dependent), opioid[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Disorder (of), opioid use, mild[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (40)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "F11.10 — Opioid abuse, uncomplicated." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/f11.10-opioid-abuse-uncomplicated

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Opioid abuse, uncomplicated

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to F11.10 in its code family, with their registry titles.

View all codes in the F11 family