Introduction

Accurate clinical documentation and coding are cornerstones of effective mental health care. For clinicians treating substance use disorders (SUDs), mastering the nuances of the ICD-10-CM system is critical for:

• Compliant billing

• Clear provider communication

• Treatment outcome tracking

• Continuity of care

This guide offers a comprehensive overview of how to apply ICD-10-CM codes for substance-related and addictive disorders—specifically in the F10–F19 categories. You’ll learn the code structure, how to align severity with DSM-5, use specifiers, and apply best documentation practices.

⚠️ Disclaimer: This article is for informational purposes only and does not substitute for legal, clinical, or coding advice. Refer to official ICD-10-CM guidelines and regulatory requirements in your jurisdiction.

ICD-10-CM Categories for SUDs (F10–F19)

Each three-character code category refers to a specific substance:

• F10 – Alcohol-related disorders

• F11 – Opioid-related disorders

• F12 – Cannabis-related disorders

• F13 – Sedative, hypnotic, or anxiolytic-related disorders

• F14 – Cocaine-related disorders

• F15 – Other stimulant-related disorders (e.g., meth, MDMA)

• F16 – Hallucinogen-related disorders

• F17 – Nicotine dependence

• F18 – Inhalant-related disorders

• F19 – Other/unknown psychoactive substance-related disorders

  • Use F19 only for true polysubstance use or unidentified substances

Code Structure: How ICD-10-CM SUD Codes Work

ICD-10-CM SUD codes follow this format: F1x.yyy

Code Breakdown:

• F1x – Substance category

• .1 – Abuse (mild)

• .2 – Dependence (moderate/severe)

• .9 – Use, unspecified

Additional Characters Provide Clinical Specificity:

• .0 – Uncomplicated

• .1 – In remission

• .2 – With intoxication

• .3 – With withdrawal

• .4 / .5 / .8 – Induced mental disorders (mood, psychotic, etc.)

• .9 – Unspecified complication/state

Example:
F11.23 = Opioid (F11) dependence (.2) with withdrawal (.3)

Mapping ICD-10-CM to DSM-5 Severity Levels

• Mild SUD (2–3 DSM-5 criteria) → Code as Abuse

  • Example: F10.10 – Alcohol abuse, uncomplicated

• Moderate/Severe SUD (4+ criteria) → Code as Dependence

  • Example: F11.20 – Opioid dependence, uncomplicated

🔑 Hierarchy Rule: Code only the highest level documented.
Dependence > Abuse > Use

Specifiers to Add Clinical Detail

✅ In Remission (F1x.11 or F1x.21)

• Requires documentation stating “in remission”

• Do not use if only “history of” is noted

• Example: F10.21 – Alcohol dependence, in remission

✅ With Intoxication (F1x.x2x)

• Used when intoxication is clinically present

• Subcodes:

  • .20 – Uncomplicated

  • .21 – With delirium

  • .22 – With hallucinations

  • .29 – Unspecified

✅ With Withdrawal (F1x.x3x)

• Most common under dependence

• Subcodes include:

  • .30 / .39 – Uncomplicated or unspecified

  • .31 – With delirium

  • .32 – With perceptual disturbance

  • (e.g., F10.231 – Alcohol withdrawal with delirium)

✅ Substance-Induced Mental Disorders

• Requires documentation of substance as cause

• Examples:

  • F11.24 – Opioid-induced mood disorder

  • F14.251 – Cocaine-induced psychosis with hallucinations

  • F1x.81 – Sexual dysfunction

  • F1x.82 – Sleep disorder

🧠 If mental illness is independent (e.g., Bipolar I + SUD), code both separately.

Special Considerations in SUD Coding

🟪 Polysubstance Use

• Code each substance individually

• Use F19 only for unspecified substances or generalized polysubstance dependence

🟪 Nicotine Dependence (F17)

• Use specific codes for cigarettes, vaping, chewing tobacco

• Non-dependent tobacco use = Z72.0

🟪 SUD vs. Poisoning/Overdose

• Use T codes from Chapter 19 for poisoning, with F codes as secondary (in emergency settings)

🟪 Prescribed Use ≠ SUD

• Don’t use F codes unless misuse/behavioral criteria are documented

• Use Z codes for appropriate long-term use

  • Example: Z79.891 – Long-term opiate use

🟪 Medical Conditions Caused by SUD

• Code both the condition and the SUD

  • Example:

    • K85.20 – Alcohol-induced pancreatitis

    • F10.20 – Alcohol dependence

Documentation Best Practices

• Name the Substance Clearly

• State the Severity or Diagnosis Type

  • Use “mild,” “moderate,” “severe,” “abuse,” or “dependence”

• Document Status (e.g., in remission, intoxicated, withdrawing)

• Link Induced Mental Disorders

  • Example: “Meth-induced psychosis”

• Avoid Ambiguity

  • Don’t use vague terms like “substance misuse”

• Document All Co-Occurring Diagnoses

💡 Use tools like Nudge to prompt for severity, status, and specifiers at the point of documentation.

Coding Examples

• Cannabis (Mild, active):
  “Mild Cannabis Use Disorder” → F12.10

• Opioid (Severe, withdrawal):
  “Severe Opioid Use Disorder, in withdrawal” → F11.23

• Alcohol (Remission):
  “Alcohol Use Disorder, severe, sustained remission” → F10.21

• Cocaine (Psychosis):
  “Cocaine-induced psychotic disorder w/ hallucinations” → F14.251

• Alcohol (Medical Complication):
  “Alcohol-induced pancreatitis” → K85.20 + F10.20

Conclusion: Precision Matters

ICD-10-CM coding for SUDs does more than drive billing—it reflects the full clinical picture of the patient’s condition.

By:

• Using accurate F10–F19 codes

• Mapping correctly to DSM-5

• Applying the right specifiers

• Avoiding common pitfalls

• Supporting your notes with clear documentation

You ensure high-quality care and smooth administrative processes.

✅ Tools like Nudge can streamline your workflow—prompting clinicians to code with accuracy while focusing on patient care.

Final Disclaimer

ICD-10-CM codes and guidelines evolve. Always consult the most current official codebooks, CMS/CDC guidelines, and payer-specific rules. This guide is based on widely accepted practices at the time of writing and should not be used as a substitute for professional clinical or legal guidance.