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Psychiatry Coding & Reimbursement Alert

Reader Question:

Don't Get Hallucinations Over Reporting Substance Related Psychosis

Question: One of our psychiatrists recently reviewed a patient and arrived at a diagnosis of opioid induced psychotic disorder. When I looked at the ICD-10 codes, I saw many codes for opioid related disorders and got confused. Which of these codes I should use to report this diagnosis?

New York Subscriber

Answer: For opioid related disorders, you should use F11- (Opioid related disorders) set of codes. In your question, you have not mentioned whether your clinician determined that the patient abused (F11.1-, Opioid abuse) or had dependency (F11.2-, Opioid dependence). You will need to identify this information in the patient notes as this will change the code selection as described above. Otherwise, you will need to use F11.9- (Opioid use, unspecified).

You have also not mentioned the type of psychotic disorder the patient is experiencing. So, once you have identified the extent of use or dependence the patient has related to the opioids, you will need to identify the specific type of psychotic disorder the patient is experiencing as this will also affect your code selection. You have different codes for psychotic disorder with hallucinations and delusions. If the patient has any other psychotic disorder, then you can choose to report an unspecified code.

For instance, if your clinician diagnoses the patient as opioid dependent with opioid induced psychotic disorder with hallucinations, you will choose to report F11.251 (Opioid dependence with opioid-induced psychotic disorder with hallucinations). On the other hand, if your clinician doesn’t mention hallucinations or delusions in the list of symptoms, you will have to use F11.259 (Opioid dependence with opioid-induced psychotic disorder, unspecified) to report the diagnosis.


Reminder: If your clinician has not identified the extent or dependence of opioid use, you will have to query your clinician as this affects your coding. Also, when reporting a psychotic disorder caused due to substance abuse, you will have to query your clinician regarding the exact symptoms the patient is experiencing.