ICD-10-CM Coding for Drug Dependence and Abuse – Simplified Guide

In ICD-10-CM, drug-related disorders are classified based on the type of substance used. Each type of drug has its own category under Chapter F (Mental and Behavioral Disorders due to psychoactive substance use).

ICD-10 Categories by Drug Type

Fourth Character – Abuse, Dependence, or Unspecified Use

In most F11–F19 categories, the fourth character usually indicates:

• .1 = Nondependent abuse

• .2 = Dependence

• .9 = Unspecified use

Example:

• F11.1 → Opioid abuse

• F11.2 → Opioid dependence

• F11.9 → Opioid use, unspecified

Additional Characters for Complications

ICD-10 provides combination codes that capture both the substance disorder and its complications, such as:

• Intoxication

• Withdrawal

• Drug-induced mood disorder

• Drug-induced psychotic disorder

• Sleep disorder

• Sexual dysfunction

This means you do not need a separate code for many complications—the ICD-10 code already includes them.

Examples of Combination Codes

• F10.251 – Alcohol dependence with alcohol-induced psychotic disorder with hallucinations

• F10.180 – Alcohol abuse with alcohol-induced anxiety disorder

• F11.250 – Heroin dependence with heroin-induced psychosis with delusions

Understanding Withdrawal

Withdrawal occurs when a person suddenly stops or reduces a drug or alcohol after regular use. Symptoms may include:

• Tremors

• Agitation or irritability

• Sleep disturbance

• Loss of appetite

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• Rapid heartbeat

• Seizures

• Hallucinations

Delirium Tremens (Severe Withdrawal)

A serious form of withdrawal that may include:

• Fever

• Confusion

• Hallucinations

• Unstable blood pressure

• Seizures

• Severe agitation

ICD-10 includes specific codes for withdrawal with delirium or perceptual disturbance.

When the Specific Drug Is Not Known (F19)

If the medical record does not clearly specify the drug type, use:

👉 Category F19 – Other psychoactive substance-related disorders

For withdrawal in abuse of unspecified substances, use:
👉 F19.13- (Other psychoactive substance abuse with withdrawal)

Coding “In Remission”

Use “in remission” codes only if the provider explicitly documents it based on clinical judgment.

How to classify remission:

• Mild substance use disorder in remission → Code as abuse in remission

• Moderate or severe substance use disorder in remission → Code as dependence in remission

📌 Important:
Do not code remission based only on nursing notes, social worker notes, or assumptions. It must come from the provider’s documentation.