Substance Use Disorder ICD-10 Codes (F10-F19) for Therapists

Quick answer

• Mild use disorder: the abuse code ending in .10, such as F10.10 alcohol, F11.10 opioid, F12.10 cannabis, F14.10 cocaine, F15.10 amphetamine-type or other stimulant.
• Moderate or severe use disorder: the dependence code ending in .20, such as F10.20, F11.20, F12.20, F14.20, F15.20. Moderate and severe share a code, so state the severity in the note.
• In early or sustained remission: .11 for mild (F10.11) and .21 for moderate or severe (F10.21).
• Withdrawal, intoxication or a substance-induced disorder: use the combination code instead of the uncomplicated one, for example F10.230 (alcohol withdrawal with a moderate or severe use disorder) or F11.23 (opioid withdrawal with a moderate or severe use disorder).
• Nicotine: dependence codes only, by product: F17.200 unspecified product, F17.210 cigarettes. Tobacco use without dependence is Z72.0.
• Not billable: the categories F10 to F19 and subcategories such as F10.1, F10.2, F10.9, F10.23 and F17.21 are headings. Report a code with all of its characters.

How F10 to F19 codes are built

The third character names the substance class. The fourth character gives the pattern of use, using the older terms that ICD-10-CM keeps in its titles. For F10-F16 and F18-F19, the fifth and sixth characters identify remission, intoxication, withdrawal or an induced disorder. F17 is different: its fifth character identifies the tobacco product and its sixth identifies the status; use the nicotine section below. No code in F10 to F19 has a seventh character; the longest have six, such as F10.239.

The ICD-10-CM guidelines set a hierarchy when more than one pattern is documented for the same substance: use plus abuse is coded as abuse only, and any combination that includes dependence is coded as dependence only. The use, unspecified codes (such as F10.90 or F12.90) are for when the provider documents that the substance use is linked to a substance-related disorder or a medical condition; they are not a code for a mild use disorder.

DSM-5-TR severity and the matching code

DSM-5-TR rates a substance use disorder by how many of its 11 criteria are met in a 12-month period: two or three is mild, four or five is moderate, and six or more is severe. ICD-10-CM lists the DSM-5-TR names as inclusion terms, for example "Alcohol use disorder, mild" under F10.10 and "Alcohol use disorder, moderate" and "Alcohol use disorder, severe" under F10.20.

Because moderate and severe share one code, a claim cannot show the difference. Write the severity, and the criteria that support it, in the assessment.

In-remission codes

DSM-5-TR uses "in early remission" when no criteria other than craving have been met for at least 3 months but less than 12 months, and "in sustained remission" at 12 months or more. Both go to the same ICD-10-CM code. The guidelines say mild use disorders in remission are coded to abuse in remission (F11.11, for example) and moderate or severe ones to dependence in remission (F11.21), and that remission codes are assigned only from provider documentation. DSM-5-TR specifiers such as "in a controlled environment" or "on maintenance therapy" are written in the note; they do not change the code.

Commonly used codes by substance

Alcohol (F10)

Opioids (F11)

Cannabis, sedatives and stimulants (F12 to F15)

Hallucinogens, inhalants and other substances (F16, F18, F19)

Category F15 includes amphetamine-related disorders and caffeine, and excludes cocaine (F14). F19 covers other or unknown substances and also includes documented indiscriminate polysubstance drug use. When a client has more than one substance use disorder, record each one that is diagnosed with its own code.

F17: nicotine dependence is different

F17 works differently from the other categories. It has only the dependence pattern (F17.2); there are no abuse or use codes. The fifth character gives the product and the sixth the status.

For ICD-10-CM code selection, follow the current Alphabetical Index and Tabular List. The tabular includes mild, moderate and severe tobacco use disorder under F17.200 when the product is unspecified; document the product and use the appropriate product-specific code when known. Z72.0 describes tobacco use NOS and is excluded from F17. Clarify conflicting documentation or claim requirements rather than choosing between these codes solely on payer preference.

How to choose the code from what the note documents

The code should be the last step, not the first. Work through the record in this order, and if the note does not support a step, document more before you code more specifically.

1. Name the substance. Code separately diagnosed substance use disorders by their substance-specific categories. F19 covers other or unknown substances and also includes documented indiscriminate polysubstance drug use. Do not use F19 merely because a client uses more than one identifiable substance.
2. Count the criteria. Record which DSM-5-TR criteria are met over the past 12 months and the resulting severity. Two or three criteria is mild (.10); four or more is moderate or severe (.20).
3. Check remission. If no criteria other than craving have been met for 3 months or more, the clinician may document early or sustained remission and the code moves to .11 or .21.
4. Add what else is present. If the clinician diagnoses intoxication, withdrawal or a substance-induced disorder (for example depressive, anxiety or sleep), pick the combination code that matches the use disorder severity: .1 with a mild use disorder, .2 with a moderate or severe one, .9 when there is no use disorder. The combination code already includes the use disorder, so do not add the uncomplicated code as well (for example, not F10.20 alongside F10.230).
5. Separate an independent disorder. If depression or anxiety is judged independent of the substance use (for example it began before the use or persists well after it stops), code it as its own disorder; see depression ICD-10 codes and anxiety, PTSD and adjustment disorder ICD-10 codes.
6. Nicotine. Code dependence by product (F17.210 for cigarettes) or Z72.0 for tobacco use without dependence.

Billing tips for substance use codes

• Match the code to the severity in the note. A note that documents five criteria supports F12.20, not F12.10. If severity changes over treatment, update the diagnosis and say why.
• Do not use the use, unspecified codes for a use disorder. F10.90 and similar codes are not DSM-5-TR use disorder codes; the guidelines limit them to substance use linked to a substance-related disorder or medical condition.
• Use complete codes. F10.2, F10.23, F13.23 and F17.21 are headings; each needs its final character.
• Keep the record consistent. The diagnosis in the note, the treatment plan and the claim should match.
• Check codes every October 1. ICD-10-CM is updated each fiscal year.

Example: documenting F12.20 (fictional)

Fictional example written for this page. The client and every detail are invented; there is no real PHI here. It shows assessment language that supports a specific code and severity.

The note supports F12.20 rather than F12.10 or F12.90: it names the substance, lists the five criteria met over 12 months (moderate), and records what was considered (withdrawal, other substances, mood). For worked notes, see SOAP notes for substance use, progress notes for substance use, DAP notes for substance use and SOAP notes for substance abuse counselors. Treatment plan example: substance use. For the wider list of codes, see the mental health ICD-10 reference and the most-used F-codes for therapy billing.

How MentalNote fits

MentalNote drafts progress notes from a recorded session (with your client's consent) or, in the Word add-in, from a summary you type. It does not assign or suggest ICD-10 codes: a draft includes a diagnosis or code only when you state one, and you choose, check and enter the code. You review every draft before it goes in the record.

MentalNote is HIPAA-compliant, with a BAA included on every plan. The free plan includes 5 web-app scribe sessions a month with no credit card; Premium is $99/month or $990/year (pricing). See AI scribe for substance use counselors and the AI SOAP note generator.