C. Pupillary constriction (or pupillary dilation due to anoxia from severe overdose) and one (or more) of the following signs or symptoms developing during, or shortly after, opioid use: 1. Drowsiness or coma.
2. Slurred speech.
3. Impairment in attention or memory.
D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another sub- stance.
Specify if:
With perceptual disturbances: This specifier may be noted in the rare instance in which hallucinations with intact reality testing or auditory, visual, or tactile illusions oc- cur in the absence of a delirium.
Coding note: The ICD-9-CM code is 292.89. The |CD-10-CM code depends on whether or not there is a comorbid opioid use disorder and whether or not there are perceptual dis- turbances.
For oploid Intoxication without perceptual disturbances: If a mild opioid use dis- order is comorbid, the |CD-10-CM code is F11.129, and it a moderate or severe opioid use disorder is comorbid, the |CD-10-CM code is F11.229. If there is no comorbid opi- oid use disorder, then the |CD-10-CM code is F11.929.
For opioid intoxication with perceptual disturbances: If a mild opioid use disorder is comorbid, the |CD-10-CM code is F11.122, and if a moderate or severe opioid use disorder is comorbid, the lCD-10-CM code is F11.222. If there is no comorbid opioid use disorder, then the lCD-10-CM code is F11.922.
The essential feature of opioid intoxication is the presence of clinically significant prob— lematic behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment) that develop dur- ing, or shortly after, opioid use (Criteria A and B). Intoxication is accompanied by pupil- lary constriction (unless there has been a severe overdose with consequent anoxia and pupillary dilation) and one or more of the following signs: drowsiness (described as be- ing ”on the nod”), slurred speech, and impairment in attention or memory (Criterion C); drowsiness may progress to coma. Individuals with opioid intoxication may demonstrate inattention to the environment, even to the point of ignoring potentially harmful events.
The signs or symptoms must not be attributable to another medical condition and are not better explained by another mental disorder (Criterion D).
Other substance intoxication. Alcohol intoxication and sedative-hypnotic intoxication can cause a clinical picture that resembles opioid intoxication. A diagnosis of alcohol or sedative-hypnotic intoxication can usually be made based on the absence of pupillary con- striction or the lack of a response to a naloxone challenge. In some cases, intoxication may be due both to opioids and to alcohol or other sedatives. In these cases, the naloxone chal- lenge will not reverse all of the sedative effects.
Other opioid-related disorders. Opioid intoxication is distinguished from the other opioid-induced disorders (e.g., opioid—induced depressive disorder, with onset during in- toxication) because the symptoms in the latter disorders predominate in the clinical pre- sentation and meet full criteria for the relevant disorder.
Diagnostic Criteria 292.0 (F11.23)
A. Presence of either of the following: 1. Cessation of (or reduction in) opioid use that has been heavy and prolonged (i.e., several weeks or longer).