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F11.20·CIM-10-CM

Opioid Use Disorder, Uncomplicated

Problematic pattern of opioid use meeting DSM-5-TR Opioid Use Disorder criteria without current intoxication, withdrawal, or specific opioid-induced complications.

Outil de dépistage recommandé

Outil de dépistage validé
DAST-10
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DSM-5-TR diagnostic criteria summary

Opioid Use Disorder requires a problematic pattern of opioid use leading to clinically significant impairment, with at least 2 of 11 criteria within a 12-month period:

  • Opioids taken in larger amounts or longer than intended.
  • Persistent desire or unsuccessful efforts to cut down.
  • Significant time spent obtaining, using, or recovering.
  • Craving for opioids.
  • Recurrent use causing failure to fulfill role obligations.
  • Continued use despite social/interpersonal problems.
  • Important activities given up or reduced.
  • Recurrent use in physically hazardous situations.
  • Continued use despite knowledge of physical/psychological problems.
  • Tolerance (excludes opioids taken under appropriate medical supervision).
  • Withdrawal (excludes opioids taken under appropriate medical supervision).

Severity: Mild (2–3 criteria), Moderate (4–5 criteria), Severe (6+ criteria). The fourth-character codes specify state: F11.10 mild uncomplicated, F11.20 moderate-severe uncomplicated, F11.21 in remission, F11.22 with intoxication, F11.23 with withdrawal, F11.24 with mood disorder, F11.25 with psychotic features.

Source: American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), p. 583–589.

Differential diagnosis

  • F11.10 OUD, Mild, meeting 2–3 criteria; severity downstream affects ICD code selection.
  • F11.21 OUD, In Remission, none of the criteria except craving have been met for ≥3 months.
  • F11.23 Opioid Withdrawal, autonomic symptoms (dilated pupils, lacrimation, rhinorrhea, yawning), gastrointestinal symptoms, restlessness, muscle aches within hours-to-days of cessation.
  • Other Substance Use Disorders, particularly co-occurring alcohol (F10.20), benzodiazepine (F13.20), and stimulant (F14.20) use; coded separately and increase overdose risk.
  • Chronic pain conditions, when long-term opioid therapy is medically supervised, tolerance/withdrawal alone do NOT meet OUD criteria.

Common comorbidities

Opioid Use Disorder has very high lifetime psychiatric comorbidity. Common co-occurring conditions: Major Depressive Disorder (F33, F32), Generalized Anxiety Disorder (F41.1), Post-Traumatic Stress Disorder (F43.10), other Substance Use Disorders (F10–F19), and chronic pain conditions. Co-administer PHQ-9, GAD-7, PCL-5, and AUDIT alongside the DAST-10 or TAPS.

Sources

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), F11.20, p. 583–589.
  • Skinner, H. A. (1982). The Drug Abuse Screening Test. Addictive Behaviors, 7(4), 363–371.
  • Centers for Disease Control and Prevention. ICD-10-CM Official Coding Guidelines.

Foire aux questions

What is ICD-11 code F11.20?

F11.20 is the ICD-11-CM code for Opioid Use Disorder, Uncomplicated, used when DSM-5-TR criteria for OUD are met without active intoxication, withdrawal, or specific opioid-induced complications. It is the most commonly used baseline OUD code.

What are the diagnostic criteria for F11.20?

DSM-5-TR Opioid Use Disorder requires a problematic pattern of opioid use leading to clinically significant impairment, with at least 2 of 11 criteria within a 12-month period: using more than intended, unsuccessful attempts to cut down, time spent obtaining/using/recovering, craving, role failure, social/interpersonal problems, giving up activities, hazardous use, continued use despite physical/psychological problems, tolerance, withdrawal. (Tolerance/withdrawal under medical supervision do NOT count.) Severity: 2–3 mild, 4–5 moderate, 6+ severe.

What scale is used to screen for F11.20?

The Drug Abuse Screening Test (DAST-10) is a 10-item self-report screener; scores 3+ suggest moderate risk and 6+ severe substance use disorder. The TAPS Tool (Tobacco, Alcohol, Prescription medications, and other Substance use) is a stepped-screener used in primary care that can identify any substance use disorder including opioids. A positive screen warrants a full clinical evaluation.

How is F11.20 different from F11.10 or F11.21?

F11.10 is OUD Mild (2–3 criteria). F11.20 is OUD Moderate-to-Severe Uncomplicated. F11.21 is OUD in Remission. Other fourth-character codes specify state: F11.22 with intoxication, F11.23 with withdrawal, F11.24 with mood disorder, F11.25 with psychotic features. F11.20 is the standard baseline code.

Does F11.20 include both prescription and illicit opioids?

Yes. F11.20 covers all opioids, prescription pain medications (oxycodone, hydrocodone, morphine, fentanyl), heroin, and synthetic opioids. Coding does not differentiate based on which opioid was used; clinical documentation should note the specific substance(s) involved for treatment planning. Medication for Opioid Use Disorder (MOUD), buprenorphine, methadone, naltrexone, is the standard of care and does not change the F11.20 code.

Is F11.20 a billable ICD-11-CM code?

Yes, F11.20 is a billable ICD-11-CM code as of the 2025 official tabular list. It is the standard reimbursed code for moderate-to-severe Opioid Use Disorder without active intoxication or withdrawal. Related billable codes in the same family include F11.10 (mild), F11.21 (in remission), F11.220 (with intoxication), and F11.23 (with withdrawal).

What are the symptoms of opioid use disorder?

Opioid Use Disorder produces a recognizable cluster of behavioral, cognitive, and physical symptoms. Core signs include strong cravings, using more opioids or longer than intended, unsuccessful attempts to cut down, and continued use despite job, relationship, or health problems. Physical signs include tolerance, withdrawal symptoms (muscle aches, sweating, gastrointestinal distress, dilated pupils, restlessness) when use stops, and high-risk behaviors such as injecting or sharing supply.

How is opioid use disorder diagnosed?

Opioid Use Disorder is diagnosed by a clinician using DSM-5-TR criteria, which require at least 2 of 11 problem-pattern criteria within a 12-month period. Diagnosis typically follows a positive DAST-10 or TAPS screen, structured clinical interview, urine toxicology, and review of medical and prescribing history. Severity is graded mild (2-3 criteria), moderate (4-5), or severe (6+) based on symptom count.

What causes opioid use disorder?

Opioid Use Disorder develops through a combination of genetic vulnerability, neurobiological adaptation, and environmental exposure. Heritability is estimated at 50% based on twin studies. Repeated opioid exposure alters mu-opioid receptor signaling and the dopamine reward system, driving tolerance and physical dependence. Environmental triggers include chronic pain, trauma history, untreated mental health conditions, and prescription-drug exposure during medical care.

Can opioid use disorder be cured?

Opioid Use Disorder is a chronic, relapsing condition that responds to long-term treatment rather than a one-time cure. Medication for Opioid Use Disorder (MOUD) with buprenorphine, methadone, or extended-release naltrexone reduces overdose death by roughly 50% and is the first-line standard of care. Combined with behavioral therapy, MOUD enables sustained recovery; many individuals stay on maintenance medication for years or indefinitely.

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