Opioid abuse, addiction, and overdoses are a serious public health problem and grouped together as Opioid Use Disorder. The National Institute on Drug Abuse says more than 115 people in the United States die daily from overdosing on opioids. The CDC estimates $78.5 billion a year is spent on healthcare, lost productivity, addiction treatment, and criminal justice involvement on prescription opioid misuse in the US.
The diagnosis of Opioid Use Disorder can be applied to someone who has at least two of the following occurrences within a 12-month period.
-Taking more opioid drugs than intended
-Wanting or trying to control opioid drug use without success
-Spending a lot of time obtaining, taking, or recovering from the effects of opioid drugs.
-Failing to carry out important roles at home, work, or school because of opioid use.
-Continuing to use opioids, despite use of the drug causing relationship or social problems.
-Giving up or reducing other activities because of opioid use.
-Using opioids even when it is physically unsafe.
-Knowing that opioid use is causing a physical or psychological problem, but continuing to take the drug anyway.
-Tolerance for opioids
-Withdrawal symptoms when opioids are not taken.
In ICD-10-CM, opioid use, abuse, and dependence are coded to category F11. Codes are chosen accordingly to whether the patient is using, abusing, or is dependent on opioids. When coding this, it is important to know the sequencing rules to select the appropriate ICD-10-CM Code.
When the documentation refers to use, abuse, and dependence of the same substance, only one code should be assigned to identify the pattern of use.
-If both use and abuse are documented, assign only the code for abuse.
-If both abuse and dependence are documented, assign only the code for dependence.
-If use, abuse, and dependence are all documented, assign only the code for dependence.
-If both use and dependence are documented, assign only the code for dependence.
Because of the hierarchy, it is very important for providers to not document “use” and “abuse” interchangeably, or document use or abuse if the patient is truly dependent.