ICD-10 F11.159
Billable / Specific HCC v28: 54Opioid abuse with opioid-induced psychotic disorder, unspecified
About ICD-10-CM F11.159
ICD-10-CM code F11.159 represents Opioid abuse with opioid-induced psychotic disorder, unspecified. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F11). The 2026 edition of ICD-10-CM F11.159 became effective on October 1, 2025.
Coding Tips for F11.159
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F11.159 is a CMS-HCC v28 risk-adjustment code (category 54). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for F11.159
Local Coverage Determinations (LCDs) from CMS MACs that list F11.159 as a covered diagnosis.
Showing top 10 of 257 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing F11.159.
1 Cigna
5 Medicare
Convert F11.159 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| F11.159 | 29289 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To F11.159
Other codes in section F10-F19 (Mental and behavioral disorders due to psychoactive substance use).
ICD-10 F11.159, Billing FAQ
Is ICD-10 code F11.159 billable? +
Yes, F11.159 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does F11.159 affect Medicare Advantage HCC risk adjustment? +
Yes. F11.159 maps to CMS-HCC v28 category 54. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with F11.159? +
Procedures frequently paired with F11.159 include: 90875, 90876.
What ICD-9 codes does F11.159 map to? +
Per CMS GEMs, F11.159 maps to ICD-9 codes: 29289. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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