Diagnosis Codes Index – Opioid related disorders

Diagnosis Codes Index – Opioid related disorders (F11)

In the new ICD-10 system for medical billing codes, there’s a specific code for anything and everything to do with opioids. There’s even a code for “opioid use, unspecified, uncomplicated“, which seems to indicate that any “use” of opioids is a medical problem in itself. 

We can see how “the medical system” is organized by looking at how healthcare services are billed. Looking at the hierarchy of categories in this billing scheme, we can discover how they see us, pain patients, using opioids.

The problems start at the top level: our “code” is listed under the category of “Mental disorders”:

Mental and behavioural disorders (F00–F99)   

• Mental disorders due to known physiological conditions (F01-F09)
• Mental and behavioral disorders due to psychoactive substance use (F10-F19)
• Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F20-F29)
• Mood [affective] disorders (F30-F39)
• Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders (F40-F48)
• Behavioral syndromes associated with physiological disturbances and physical factors (F50-F59)
• Disorders of adult personality and behavior (F60-F69)
• Intellectual disabilities (F70-F79)
• Pervasive and specific developmental disorders (F80-F89)
• Behavioral and emotional disorders with onset usually occurring in childhood and adolescence (F90-F98)
• Unspecified mental disorder (F99)

As the descriptions become more specific, the language changes, assuming the tone of a righteous regulator chiding us for causing our own psychological misery by “using” an opioid:

• Mental and behavioral disorders due to psychoactive substance use (F10-F19)

Now we’re getting closer to the depth of the problem, where opioids have their own category:

• F11 – ‘Opioid-related’ disorders.

The long list of such disorders is in three sections:

• F11.1 – Opioid abuse,
• F11.2 – Opioid dependence, and
  (with a gap in numbers for future use)
• F11.9 – Opioid use, unspecified

This categorizes not just “abuse” or “dependence” but any “use” of opioids as a “disorder”,  even without any problems or complications, under the sub-title of

• F11.90 – Opioid use, unspecified, uncomplicated

ICD-10 F11.90 is a billable code used to specify a medical diagnosis of opioid use, unspecified, uncomplicated. The code is valid for the year 2019 for the submission of HIPAA-covered transactions.

There we are, pain patients using prescribed opioids as directed for pain relief, grouped with the same template of problems attributed to “dependence” and “abuse”:

• F11.92 – Opioid use, unspecified with intoxication
• F11.920 – Opioid use, unspecified with intoxication, uncomplicated
• F11.921 – Opioid use, unspecified with intoxication delirium
• F11.922 – Opioid use, unsp w intoxication with perceptual disturbance
• F11.929 – Opioid use, unspecified with intoxication, unspecified
• F11.93 – Opioid use, unspecified with withdrawal
• F11.94 – Opioid use, unspecified with opioid-induced mood disorder
• F11.95 – Opioid use, unsp with opioid-induced psychotic disorder
• F11.950 – Opioid use, unsp w opioid-induc psych disorder w delusions
• F11.951 – Opioid use, unsp w opioid-induc psych disorder w hallucin
• F11.959 – Opioid use, unsp w opioid-induced psychotic disorder, unsp
• F11.98 – Opioid use, unspecified with oth opioid-induced disorder
• F11.981 – Opioid use, unsp with opioid-induced sexual dysfunction
• F11.982 – Opioid use, unspecified with opioid-induced sleep disorder
• F11.988 – Opioid use, unspecified with other opioid-induced disorder
• F11.99 – Opioid use, unsp with unspecified opioid-induced disorder

These same categories (F11.9nn) are listed under the sections for “abuse” and “dependence”.

Looking at our (pain patients taking opioids) place in this schema,

• Mental and behavioural disorders (F00–F99)
  • Mental and behavioral disorders due to psychoactive substance use (F10-F19)
    • Opioid related disorders (F11)

it’s clear that any use of opioids is considered problematic and in need of medical treatment to discontinue this troublesome medication.

At first, this looks like just a pile of insignificant bureaucratic bean-counter excrement, but anything that involves money is far from insignificant.

How money flows through healthcare and where it “sticks” is determined by these billing codes and I’d bet that’s what the healthcare CEOs are most focused upon.

No matter how ridiculous it seems, we have to remember:

“If it can be billed, it will be used”.

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At least, Ehlers-Danlos gets is own billing code buried deep in the hierarchy of “congenital” disorders:

Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)

• Congenital malformations of the nervous system (Q00-Q07)
• Congenital malformations of eye, ear, face and neck (Q10-Q18)
• Congenital malformations of the circulatory system (Q20-Q28)
• Congenital malformations of the respiratory system (Q30-Q34)
• Cleft lip and cleft palate (Q35-Q37)
• Other congenital malformations of the digestive system (Q38-Q45)
• Congenital malformations of genital organs (Q50-Q56)
• Congenital malformations of the urinary system (Q60-Q64)
• Congenital malformations and deformations of the musculoskeletal system (Q65-Q79)
• Other congenital malformations (Q80-Q89)
• Chromosomal abnormalities, not elsewhere classified (Q90-Q99)

Congenital malformations and deformations of the musculoskeletal system (Q65-Q79)

• Congenital deformities of hip (Q65)
• Congenital deformities of feet (Q66)
• Congenital ms deformities of head, face, spine and chest (Q67)
• Other congenital musculoskeletal deformities (Q68)
• Polydactyly (Q69)
• Syndactyly (Q70)
• Reduction defects of upper limb (Q71)
• Reduction defects of lower limb (Q72)
• Reduction defects of unspecified limb (Q73)
• Other congenital malformations of limb(s) (Q74)
• Other congenital malformations of skull and face bones (Q75)
• Congenital malformations of spine and bony thorax (Q76)
• Osteochndrdys w defects of growth of tubular bones and spine (Q77)
• Other osteochondrodysplasias (Q78)
• Congenital malformations of musculoskeletal system, NEC (Q79)

Congenital malformations of musculoskeletal system, NEC (Q79)

• Q79 – Congenital malformations of musculoskeletal system, NEC
• Q79.0 – Congenital diaphragmatic hernia
• Q79.1 – Other congenital malformations of diaphragm
• Q79.2 – Exomphalos
• Q79.3 – Gastroschisis
• Q79.4 – Prune belly syndrome
• Q79.5 – Other congenital malformations of abdominal wall
• Q79.51 – Congenital hernia of bladder
• Q79.59 – Other congenital malformations of abdominal wall
• Q79.6 – Ehlers-Danlos syndrome
• Q79.8 – Other congenital malformations of musculoskeletal system
• Q79.9 – Congenital malformation of musculoskeletal system, unsp

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But according to our symptoms, we could also be categorized in many other disorders of various body systems:

Diseases of the circulatory system (I00–I99)

• Acute rheumatic fever (I00-I02)
• Chronic rheumatic heart diseases (I05-I09)
• Hypertensive diseases (I10-I16)
• Ischemic heart diseases (I20-I25)
• Pulmonary heart disease and diseases of pulmonary circulation (I26-I28)
• Other forms of heart disease (I30-I52)
• Cerebrovascular diseases (I60-I69)
• Diseases of arteries, arterioles and capillaries (I70-I79)
  
  • Other peripheral vascular diseases (I73) – [flabby veins lead to poor circulation]
• Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified (I80-I89)
  • Varicose veins of lower extremities (I83)
• Other and unspecified disorders of the circulatory system (I95-I99)

Diseases of the digestive system (K00–K93)

• Diseases of oral cavity and salivary glands (K00-K14)
• Diseases of esophagus, stomach and duodenum (K20-K31)
  • Other diseases of stomach and duodenum (K31) [gastroparesis]
•  Diseases of appendix (K35-K38)
• Hernia (K40-K46)
• Noninfective enteritis and colitis (K50-K52) 
  • Diverticular disease of intestine (K57)
• Other diseases of intestines (K55-K64)
• Diseases of peritoneum and retroperitoneum (K65-K68)
• Diseases of liver (K70-K77)
• Disorders of gallbladder, biliary tract and pancreas (K80-K87)
• Other diseases of the digestive system (K90-K95)

Diseases of the skin and subcutaneous tissue (L00–L99)

• Infections of the skin and subcutaneous tissue (L00-L08)
• Bullous disorders (L10-L14)
• Dermatitis and eczema (L20-L30)
• Papulosquamous disorders (L40-L45)
• Urticaria and erythema (L49-L54)  [ferocious itching episodes]
• Radiation-related disorders of the skin and subcutaneous tissue (L55-L59)
• Disorders of skin appendages (L60-L75)
• Intraoperative and postprocedural complications of skin and subcutaneous tissue (L76)  [skin so fragile it tears stiches]
• Other disorders of the skin and subcutaneous tissue (L80-L99)

Diseases of the musculoskeletal system and connective tissue (M00–M99)

• Infectious arthropathies (M00-M02)
• Autoinflammatory syndromes (M04)
• Inflammatory polyarthropathies (M05-M14)
• Osteoarthritis (M15-M19)
• Other joint disorders (M20-M25)
• Dentofacial anomalies [including malocclusion] and other disorders of jaw (M26-M27)
• Systemic connective tissue disorders (M30-M36)
  • Systemic disorders of conn tiss in diseases classd elswhr (M36) [from EDS]
• Deforming dorsopathies (M40-M43)
• Spondylopathies (M45-M49)
• Other dorsopathies (M50-M54)
• Disorders of muscles (M60-M63)
  • Disorders of muscle in diseases classified elsewhere (M63)
• Disorders of synovium and tendon (M65-M67)
• Other soft tissue disorders (M70-M79)
• Disorders of bone density and structure (M80-M85)
• Other osteopathies (M86-M90)
• Chondropathies (M91-M94)
• Other disorders of the musculoskeletal system and connective tissue (M95)
• Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified (M96)
• Periprosthetic fracture around internal prosthetic joint (M97)
• Biomechanical lesions, not elsewhere classified (M99)