F11.121 - Opioid abuse with intoxication delirium

Diagnostic Related Groups - MS-DRG Mapping

The is diagnosis code is grouped in the following groups for version MS-DRG V40.0 What are Diagnostic Related Groups?
The Diagnostic Related Groups (DRGs) are a patient classification scheme which provides a means of relating the type of patients a hospital treats. The DRGs divides all possible principal diagnoses into mutually exclusive principal diagnosis areas referred to as Major Diagnostic Categories (MDC). applicable from 10/01/2022 through 09/30/2023.

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Patient Education

Delirium

What is delirium?

Delirium is a mental state in which you are confused, disoriented, and not able to think or remember clearly. It usually starts suddenly. It is often temporary and treatable.

There are three types of delirium:

• Hypoactive, where you are not active and seem sleepy, tired, or depressed
• Hyperactive, where you are restless or agitated
• Mixed, where you change back and forth between being hypoactive and hyperactive

What causes delirium?

There are many different problems that can cause delirium. Some of the more common causes include:

• Alcohol or drugs, either from intoxication or withdrawal. This includes a serious type of alcohol withdrawal syndrome called delirium tremens. It usually happens to people who stop drinking after years of alcohol abuse.
• Dehydration and electrolyte imbalances
• Dementia
• Hospitalization, especially in intensive care
• Infections, such as urinary tract infections, pneumonia, and the flu
• Medicines. This could be a side effect of a medicine, such as sedatives or opioids. Or it could be withdrawal after stopping a medicine.
• Metabolic disorders
• Organ failure, such as kidney or liver failure
• Poisoning
• Serious illnesses
• Severe pain
• Sleep deprivation
• Surgeries, including reactions to anesthesia

Who is at risk for delirium?

Certain factors put you at risk for delirium, including:

• Being in a hospital or nursing home
• Dementia
• Having a serious illness or more than one illness
• Having an infection
• Older age
• Surgery
• Taking medicines that affect the mind or behavior
• Taking high doses of pain medicines, such as opioids

What are the symptoms of delirium?

The symptoms of delirium usually start suddenly, over a few hours or a few days. They often come and go. The most common symptoms include:

• Changes in alertness (usually more alert in the morning, less at night)
• Changing levels of consciousness
• Confusion
• Disorganized thinking, talking in a way that doesn't make sense
• Disrupted sleep patterns, sleepiness
• Emotional changes: anger, agitation, depression, irritability, overexcitement
• Hallucinations and delusions
• Incontinence
• Memory problems, especially with short-term memory
• Trouble concentrating

How is delirium diagnosed?

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• Physical and neurological exams
• Mental status testing
• Lab and diagnostic imaging tests

Delirium and dementia have similar symptoms, so it can be hard to tell them apart. They can also occur together. Delirium starts suddenly and can cause hallucinations. The symptoms may get better or worse and can last for hours or weeks. On the other hand, dementia develops slowly and does not cause hallucinations. The symptoms are stable and may last for months or years.

What are the treatments for delirium?

Treatment of delirium focuses on the causes and symptoms of delirium. The first step is to identify the cause. Often, treating the cause will lead to a full recovery. The recovery may take some time - weeks or sometimes even months. In the meantime, there may be treatments to manage the symptoms, such as:

• Controlling the environment, which includes making sure that the room is quiet and well-lit, having clocks or calendars in view, and having family members around
• Medicines, including those that control aggression or agitation and pain relievers if there is pain
• If needed, making sure that the person has a hearing aid, glasses, or other devices for communication

Can delirium be prevented?

Treating the conditions that can cause delirium may reduce the risk of getting it. Hospitals can help lower the risk of delirium by avoiding sedatives and making sure that the room is kept quiet, calm, and well-lit. It can also help to have family members around and to have the same staff members treat the person.

Drug Use and Addiction

What are drugs?

Drugs are chemical substances that can change how your body and mind work. They include prescription medicines, over-the-counter medicines, alcohol, tobacco, and illegal drugs.

What is drug use?

Drug use, or misuse, includes:

• Using illegal substances, such as
• Anabolic steroids
• Club drugs
• Cocaine
• Heroin
• Inhalants
• Marijuana
• Methamphetamines
• Misusing prescription medicines, including opioids. This means taking the medicines in a different way than the health care provider prescribed. This includes
• Taking a medicine that was prescribed for someone else
• Taking a larger dose than you are supposed to
• Using the medicine in a different way than you are supposed to. For example, instead of swallowing your tablets, you might crush and then snort or inject them.
• Using the medicine for another purpose, such as getting high
• Misusing over-the-counter medicines, including using them for another purpose and using them in a different way than you are supposed to

Drug use is dangerous. It can harm your brain and body, sometimes permanently. It can hurt the people around you, including friends, families, kids, and unborn babies. Drug use can also lead to addiction.

What is drug addiction?

Drug addiction is a chronic brain disease. It causes a person to take drugs repeatedly, despite the harm they cause. Repeated drug use can change the brain and lead to addiction.

The brain changes from addiction can be lasting, so drug addiction is considered a "relapsing" disease. This means that people in recovery are at risk for taking drugs again, even after years of not taking them.

Does everyone who takes drugs become addicted?

Not everyone who uses drugs becomes addicted. Everyone's bodies and brains are different, so their reactions to drugs can also be different. Some people may become addicted quickly, or it may happen over time. Other people never become addicted. Whether or not someone becomes addicted depends on many factors. They include genetic, environmental, and developmental factors.

Who is at risk for drug addiction?

Various risk factors can make you more likely to become addicted to drugs, including:

• Your biology. People can react to drugs differently. Some people like the feeling the first time they try a drug and want more. Others hate how it feels and never try it again.
• Mental health problems. People who have untreated mental health problems, such as depression, anxiety, or attention deficit/hyperactivity disorder (ADHD) are more likely to become addicted. This can happen because drug use and mental health problems affect the same parts of the brain. Also, people with these problems may use drugs to try to feel better.
• Trouble at home. If your home is an unhappy place or was when you were growing up, you might be more likely to have a drug problem.
• Trouble in school, at work, or with making friends. You might use drugs to get your mind off these problems.
• Hanging around other people who use drugs. They might encourage you to try drugs.
• Starting drug use when you're young. When kids use drugs, it affects how their bodies and brains finish growing. This increases your chances of becoming addicted when you're an adult.

What are the signs that someone has a drug problem?

Signs that someone has a drug problem include:

• Changing friends a lot
• Spending a lot of time alone
• Losing interest in favorite things
• Not taking care of themselves - for example, not taking showers, changing clothes, or brushing their teeth
• Being really tired and sad
• Eating more or eating less than usual
• Being very energetic, talking fast, or saying things that don't make sense
• Being in a bad mood
• Quickly changing between feeling bad and feeling good
• Sleeping at strange hours
• Missing important appointments
• Having problems at work or at school
• Having problems in personal or family relationships

What are the treatments for drug addiction?

Treatments for drug addiction include counseling, medicines, or both. Research shows that combining medicines with counseling gives most people the best chance of success.

The counseling may be individual, family, and/or group therapy. It can help you:

• Understand why you got addicted
• See how drugs changed your behavior
• Learn how to deal with your problems so you won't go back to using drugs
• Learn to avoid places, people, and situations where you might be tempted to use drugs

Medicines can help with the symptoms of withdrawal. For addiction to certain drugs, there are also medicines that can help you re-establish normal brain function and decrease your cravings.

If you have a mental disorder along with an addiction, it is known as a dual diagnosis. It is important to treat both problems. This will increase your chance of success.

If you have a severe addiction, you may need hospital-based or residential treatment. Residential treatment programs combine housing and treatment services.

Can drug use and addiction be prevented?

Drug use and addiction are preventable. Prevention programs involving families, schools, communities, and the media may prevent or reduce drug use and addiction. These programs include education and outreach to help people understand the risks of drug use.

NIH: National Institute on Drug Abuse

Opioid Misuse and Addiction

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers, such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid. Some opioids are made from the opium plant, and others are synthetic (man-made).

A doctor may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some doctors prescribe them for chronic pain.

Opioids can cause side effects such as drowsiness, mental fog, nausea, and constipation. They may also cause slowed breathing, which can lead to overdose deaths. If someone has signs of an overdose, call 911:

• The person's face is extremely pale and/or feels clammy to the touch
• Their body goes limp
• Their fingernails or lips have a purple or blue color
• They start vomiting or making gurgling noises
• They cannot be awakened or are unable to speak
• Their breathing or heartbeat slows or stops

Other risks of using prescription opioids include dependence and addiction. Dependence means feeling withdrawal symptoms when not taking the drug. Addiction is a chronic brain disease that causes a person to compulsively seek out drugs, even though they cause harm. The risks of dependence and addiction are higher if you misuse the medicines. Misuse can include taking too much medicine, taking someone else's medicine, taking it in a different way than you are supposed to, or taking the medicine to get high.

Opioid misuse, addiction, and overdoses are serious public health problems in the United States. Another problem is that more women are misusing opioids during pregnancy. This can lead to babies being addicted and going through withdrawal, known as neonatal abstinence syndrome (NAS). Opioid misuse may sometimes also lead to heroin use, because some people switch from prescription opioids to heroin.

The main treatment for prescription opioid addiction is medication-assisted treatment (MAT). It includes medicines, counseling, and support from family and friends. MAT can help you stop using the drug, get through withdrawal, and cope with cravings. There is also a medicine called naloxone which can reverse the effects of an opioid overdose and prevent death, if it is given in time.

To prevent problems with prescription opioids, be sure to follow your doctor's instructions when taking them. Do not share your medicines with anyone else. Contact your doctor if you have any concerns about taking the medicines.

NIH: National Institute on Drug Abuse

Code History

• FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
• FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
• FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
• FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
• FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
• FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
• FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
• FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016 (First year ICD-10-CM implemented into the HIPAA code set)