ICD-10 F11.181
Billable / Specific HCC v28: 55Opioid abuse with opioid-induced sexual dysfunction
About ICD-10-CM F11.181
ICD-10-CM code F11.181 represents Opioid abuse with opioid-induced sexual dysfunction. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F11). The 2026 edition of ICD-10-CM F11.181 became effective on October 1, 2025.
Coding Tips for F11.181
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F11.181 is a CMS-HCC v28 risk-adjustment code (category 55). 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 F11.181
Local Coverage Determinations (LCDs) from CMS MACs that list F11.181 as a covered diagnosis.
Showing top 10 of 298 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing F11.181.
5 Medicare
CPT Codes Commonly Billed with F11.181
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 96121 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 96137 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 96116 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 96132 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 90838 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- G0177 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 96146 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 90846 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- G0411 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 96112 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
Convert F11.181 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 |
|---|---|---|
| F11.181 | 29289 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To F11.181
Other codes in section F10-F19 (Mental and behavioral disorders due to psychoactive substance use).
ICD-10 F11.181, Billing FAQ
Is ICD-10 code F11.181 billable? +
Yes, F11.181 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does F11.181 affect Medicare Advantage HCC risk adjustment? +
Yes. F11.181 maps to CMS-HCC v28 category 55. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with F11.181? +
Procedures frequently paired with F11.181 include: 96121, 96137, 96116, 96132, 90838.
What ICD-9 codes does F11.181 map to? +
Per CMS GEMs, F11.181 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 May 31, 2026.
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