ICD-10 F11.93
Billable / Specific HCC v28: 55 CCOpioid use, unspecified with withdrawal
About ICD-10-CM F11.93
ICD-10-CM code F11.93 represents Opioid use, unspecified with withdrawal. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F11). The 2026 edition of ICD-10-CM F11.93 became effective on October 1, 2025.
Coding Tips for F11.93
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F11.93 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.
F11.93 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Type 1 Excludes
Pure excludes, these codes can never be coded together with F11.93. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- opioid use, unspecified with intoxication (F11.92-)
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.
Inpatient DRG Impact, CC
codes Opioid use, unspecified with withdrawal. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for F11.93
Local Coverage Determinations (LCDs) from CMS MACs that list F11.93 as a covered diagnosis.
Showing top 10 of 238 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing F11.93.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with F11.93
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- G2215 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G2073 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G2067 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G2079 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G0137 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G2080 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G2075 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G2068 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G2074 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G0534 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
Convert F11.93 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 |
|---|---|---|
| F11.93 | 2920 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To F11.93
Other codes in section F10-F19 (Mental and behavioral disorders due to psychoactive substance use).
ICD-10 F11.93, Billing FAQ
Is ICD-10 code F11.93 billable? +
Yes, F11.93 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for F11.93? +
Type 1 Excludes (never code together with F11.93): opioid use, unspecified with intoxication (F11.92-)
Does F11.93 affect Medicare Advantage HCC risk adjustment? +
Yes. F11.93 maps to CMS-HCC v28 category 55. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is F11.93 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with F11.93? +
Procedures frequently paired with F11.93 include: G2215, G2073, G2067, G2079, G0137.
What ICD-9 codes does F11.93 map to? +
Per CMS GEMs, F11.93 maps to ICD-9 codes: 2920. 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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