F11.282 - Opioid dependence with opioid-induced sleep disorder

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

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

Prescription Drug Misuse

If you take a medicine in a way that is different from what the doctor prescribed, it is called prescription drug misuse. It could be:

• Taking a medicine that was prescribed for someone else
• Taking a larger dose than you are supposed to
• Taking the medicine in a different way than you are supposed to. This might be crushing tablets and then snorting or injecting them.
• Using the medicine for another purpose, such as getting high

Misusing some prescription drugs can lead to addiction. These include opioids, sedatives, tranquilizers, and stimulants.

Every medicine has some risk of side effects. Doctors take this into account when prescribing medicines. People who misuse these drugs may not understand the risks. The medicines may not be safe for them, especially at higher doses or when taken with other medicines.

NIH: National Institute on Drug Abuse

Sleep Disorders

What is sleep?

Sleep is a complex biological process. While you are sleeping, you are unconscious, but your brain and body functions are still active. They are doing a number of important jobs that help you stay healthy and function at your best. So when you don't get enough quality sleep, it does more than just make you feel tired. It can affect your physical and mental health, thinking, and daily functioning.

What are sleep disorders?

Sleep disorders are conditions that disturb your normal sleep patterns. There are more than 80 different sleep disorders. Some major types include:

• Insomnia - being unable to fall asleep and stay asleep. This is the most common sleep disorder.
• Sleep apnea - a breathing disorder in which you stop breathing for 10 seconds or more during sleep
• Restless leg syndrome (RLS) - a tingling or prickly sensation in your legs, along with a powerful urge to move them
• Hypersomnia - being unable to stay awake during the day. This includes narcolepsy, which causes extreme daytime sleepiness.
• Circadian rhythm disorders - problems with the sleep-wake cycle. They make you unable to sleep and wake at the right times.
• Parasomnia - acting in unusual ways while falling asleep, sleeping, or waking from sleep, such as walking, talking, or eating

Some people who feel tired during the day have a true sleep disorder. But for others, the real problem is not allowing enough time for sleep. It's important to get enough sleep every night. The amount of sleep you need depends on several factors, including your age, lifestyle, health, and whether you have been getting enough sleep recently. Most adults need about 7-8 hours each night.

What causes sleep disorders?

There are different causes for different sleep disorders, including:

• Other conditions, such as heart disease, lung disease, nerve disorders, and pain
• Mental illnesses, including depression and anxiety
• Medicines
• Genetics

Sometimes the cause is unknown.

There are also some factors that can contribute to sleep problems, including:

• Caffeine and alcohol
• An irregular schedule, such as working the night shift
• Aging. As people age, they often get less sleep or spend less time in the deep, restful stage of sleep. They are also more easily awakened.

What are the symptoms of sleep disorders?

The symptoms of sleep disorders depend on the specific disorder. Some signs that you may have a sleep disorder include that:

• You regularly take more than 30 minutes each night to fall asleep
• You regularly wake up several times each night and then have trouble falling back to sleep, or you wake up too early in the morning
• You often feel sleepy during the day, take frequent naps, or fall asleep at the wrong times during the day
• Your bed partner says that when you sleep, you snore loudly, snort, gasp, make choking sounds, or stop breathing for short periods
• You have creeping, tingling, or crawling feelings in your legs or arms that are relieved by moving or massaging them, especially in the evening and when trying to fall asleep
• Your bed partner notices that your legs or arms jerk often during sleep
• You have vivid, dreamlike experiences while falling asleep or dozing
• You have episodes of sudden muscle weakness when you are angry or fearful, or when you laugh
• You feel as though you cannot move when you first wake up

How are sleep disorders diagnosed?

To make a diagnosis, your health care provider will use your medical history, your sleep history, and a physical exam. You may also have a sleep study (polysomnogram). The most common types of sleep studies monitor and record data about your body during a full night of sleep. The data includes:

• Brain wave changes
• Eye movements
• Breathing rate
• Blood pressure
• Heart rate and electrical activity of the heart and other muscles

Other types of sleep studies may check how quickly you fall asleep during daytime naps or whether you are able to stay awake and alert during the day.

What are the treatments for sleep disorders?

Treatments for sleep disorders depend on which disorder you have. They may include:

• Good sleep habits and other lifestyle changes, such as a healthy diet and exercise
• Cognitive behavioral therapy or relaxation techniques to reduce anxiety about getting enough sleep
• CPAP (continuous positive airway pressure) machine for sleep apnea
• Bright light therapy (in the morning)
• Medicines, including sleeping pills. Usually, providers recommend that you use sleeping pills for a short period of time.
• Natural products, such as melatonin. These products may help some people but are generally for short-term use. Make sure to check with your health care provider before you take any of them.

Opioid addiction

Opioid addiction is a long-lasting (chronic) disease that can cause major health, social, and economic problems. Opioids are a class of drugs that act in the nervous system to produce feelings of pleasure and pain relief. Some opioids are legally prescribed by healthcare providers to manage severe and chronic pain. Commonly prescribed opioids include oxycodone, fentanyl, buprenorphine, methadone, oxymorphone, hydrocodone, codeine, and morphine. Some other opioids, such as heroin, are illegal drugs of abuse.

Opioid addiction is characterized by a powerful, compulsive urge to use opioid drugs, even when they are no longer required medically. Opioids have a high potential for causing addiction in some people, even when the medications are prescribed appropriately and taken as directed. Many prescription opioids are misused or diverted to others. Individuals who become addicted may prioritize getting and using these drugs over other activities in their lives, often negatively impacting their professional and personal relationships. It is unknown why some people are more likely to become addicted than others.

Opioids change the chemistry of the brain and lead to drug tolerance, which means that over time the dose needs to be increased to achieve the same effect. Taking opioids over a long period of time produces dependence, such that when people stop taking the drug, they have physical and psychological symptoms of withdrawal (such as muscle cramping, diarrhea, and anxiety). Dependence is not the same thing as addiction; although everyone who takes opioids for an extended period will become dependent, only a small percentage also experience the compulsive, continuing need for the drug that characterizes addiction.

Opioid addiction can cause life-threatening health problems, including the risk of overdose. Overdose occurs when high doses of opioids cause breathing to slow or stop, leading to unconsciousness and death if the overdose is not treated immediately. Both legal and illegal opioids carry a risk of overdose if a person takes too much of the drug, or if opioids are combined with other drugs (particularly tranquilizers called benzodiazepines).

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)