Diagnosis and Coding of Opioid Misuse: A Systematic Scoping Review and Implementation Framework.

Abstract

Objective: To evaluate current administrative coding practices for opioid misuse within the World Health Organization's International Classification of Diseases (ICD) framework and develop standardized documentation recommendations.

Design: Systematic scoping review following PRISMA-ScR guidelines.

Setting: Analysis of studies using administrative databases, including electronic health records, insurance claims, and national healthcare utilization databases.

Subjects: Studies published in peer-reviewed journals examining administrative codes for opioid misuse, excluding those focused solely on illicit drugs, opioid use disorder, or using only natural language processing/qualitative methods.

Methods: Comprehensive search of Embase, Medline, Google Scholar, and PubMed databases following PRISMA-S extension guidelines. Three independent reviewers screened articles and extracted data. Study quality was assessed using a modified Newcastle-Ottawa Scale.

Results: Of 9,561 initial records, 19 studies met inclusion criteria. The use of ICD-10 code F11.9* (Opioid use) emerged as the most referenced method for documenting opioid misuse, distinguishing it from opioid use disorder methods (F11.1, opioid abuse; F11.2, opioid dependence). Studies demonstrated significant heterogeneity in coding practices, resulting in code-based definitions identifying only approximately 50% of cases compared to more comprehensive clinical assessment approaches.

Conclusions: While ICD-10 code F11.9* can effectively document opioid misuse as distinct from opioid use disorder, successful implementation requires consensus on the clinical definition of opioid misuse and documentation in the form of clear clinical guidelines and operationalized through enhanced electronic health record integration. Future research should focus on validating these approaches across diverse healthcare settings.