What Is ICD-10 Code F10.11? Expert Guide to Alcohol Abuse in Remission

Medical coding accuracy plays a vital role in documenting patient care and healthcare reimbursement. ICD 10 code F10.11 specifically designates "Alcohol abuse, in remission" and became effective on October 1, 2024. Healthcare providers use this billable code to receive proper reimbursement for services that help patients recover from alcohol use disorders.

ICD 10 guidelines have specific criteria for documenting alcohol use disorder cases in remission. The code F10.11 covers both "Alcohol use disorder, mild, in early remission" and "Alcohol use disorder, mild, in sustained remission." This code belongs to the broader category of mental and behavioral disorders due to psychoactive substance use (F10-F19). Healthcare providers must document the patient's problematic alcohol use history, verify current symptom absence, and show that the patient managed to keep remission for a substantial period.

This piece explains how to apply the alcoholism in remission ICD 10 code correctly. You'll discover related CPT codes for treatment and documentation requirements that help prevent claim denials.

What is ICD-10 Code F10.11?

The ICD-10 code F10.11 stands for "Alcohol abuse, in remission." This medical classification became effective in the 2025 edition of ICD-10-CM on October 1, 2024. The code's meaning is more specific than regular medical terms because it belongs to a standardized diagnostic system used worldwide.

Definition and classification

Healthcare providers can bill using F10.11, a specific ICD-10-CM code, to show a diagnosis and get reimbursement. The classification matches two clinical scenarios:

• Alcohol use disorder, mild, in early remission

• Alcohol use disorder, mild, in sustained remission

A patient with this code has a documented history of alcohol abuse but doesn't currently drink or show problematic alcohol use. This code is different from F10.10 (alcohol abuse, uncomplicated) because the remission status shows the patient's condition has improved.

Medical professionals should know what this code doesn't cover. F10.11 doesn't include:

• Alcohol dependence (F10.2-)

• Alcohol use, unspecified (F10.9-)

On top of that, doctors might need to add a blood alcohol level code (Y90.-) if needed.

Where it fits in the ICD-10 hierarchy

The code F10.11 belongs to a well-laid-out system in ICD-10. You'll find it under:

• Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01-F99)

• Category F10: Alcohol related disorders

• Subcategory F10.1: Alcohol abuse

Medical experts classify this code as "Mental and substance use disorders in remission" with CCSR Category Code MBD026. Doctors use this code by default for main diagnosis in both inpatient and outpatient cases.

The code connects to other similar codes like:

• F10.10: Alcohol abuse, uncomplicated

• F10.12: Alcohol abuse with intoxication

• F10.13: Alcohol abuse with withdrawal

The Diagnostic Related Group system places F10.11 in MS-DRG v42.0 categories, mainly groups 894-897, which include alcohol and drug abuse or dependence cases with various modifiers.

When to Use F10.11 for Alcohol Abuse in Remission

Medical providers need careful clinical assessment and documentation to apply the alcohol abuse in remission ICD 10 code correctly. The F10.11 code should be assigned based on provider documentation and clinical judgment. Healthcare professionals must know how to use this code to ensure accurate billing and proper patient care.

Documented history of alcohol abuse

The ICD 10 code for alcohol abuse in remission needs:

• Provider documentation that confirms prior alcohol abuse

• Medical records that show previous problematic drinking patterns

• Provider's assessment that confirms mild alcohol use disorder criteria

• Clear statements about remission status to prevent audit problems

The difference between F10.11 and F10.21 is crucial. F10.11 represents mild alcohol use disorder in remission, while F10.21 indicates moderate or severe alcohol use disorder in remission. The provider's clinical judgment determines the selection of remission codes for categories F10-F19.

No current symptoms or complications

Patients must meet these criteria for alcoholism in remission ICD 10 coding:

They should show no signs of active alcohol abuse. This means the patient doesn't display patterns of maladaptive alcohol use. There should be no physical or psychological complications that link directly to alcohol abuse.

The patient should have no legal, social, or occupational problems related to alcohol use. The F10.11 code would not be appropriate if the patient receives treatment for active alcohol use disorder.

Evidence of early or sustained remission

The alcohol abuse in remission ICD 10 code applies to both early and sustained recovery periods. Early remission refers to patients who managed to keep sobriety or controlled drinking during their first year of recovery.

Sustained remission points to longer periods of stability. Research shows substantial remission rates from alcohol dependence, with one study reporting a 59% remission rate. The study found that women, older individuals, and married people achieved remission more often.

People often achieve remission without professional help. Studies show that most people reduce their drinking without treatment. But those who chose complete abstinence were more likely to seek treatment compared to moderate drinkers (44.4% versus 16.0%).

Related Codes and Exclusions to Know

Medical professionals need to understand the relationships between similar codes and exclusion notes to navigate alcohol-related diagnostic codes. Accurate billing and proper patient classification depend on careful attention to these connections during the coding process.

F10.10 vs F10.11: Key differences

The main difference between these codes comes down to the patient's current status:

• F10.10 (Alcohol abuse, uncomplicated) - Shows a current, active mild alcohol use disorder

• F10.11 (Alcohol abuse, in remission) - Shows mild alcohol use disorder that is either in early or sustained remission

Medical coders should use F10.11 as the alcohol abuse in remission ICD 10 code when patient records confirm no current problematic alcohol use. The classification system added codes for substance use disorders in remission on October 1, 2017.

Excludes1 and Excludes2 notes

ICD-10 has two critical exclusion indicators that guide coding decisions:

Excludes1 notes show conditions that cannot happen together. The alcoholism in remission ICD 10 code F10.11's Excludes1 notes prevent using:

• Alcohol dependence codes (F10.2-)

• Alcohol use, unspecified codes (F10.9-)

Coders cannot use F10.11 with these codes because they represent diagnoses that cannot exist together.

Excludes2 notes point to conditions that the code does not cover but might exist simultaneously. Coders can report both codes together when two conditions have an Excludes2 relationship and the patient has both conditions.

Use additional code for blood alcohol level (Y90.-)

The guidelines for alcohol abuse in remission ICD 10 require an extra Y90.- code when blood alcohol levels appear in documentation. Y90 codes range from:

• Y90.0 (Blood alcohol level less than 20 mg/100 ml)

• Through increasing levels

• To Y90.8 (Blood alcohol level of 240 mg/100 ml or more)

Y90.9 shows alcohol presence in blood without a specified level. Since F10.11 represents remission, Y90 codes become relevant mostly for historical measurements or remission status verification.

Billing and Reimbursement Considerations

Medical providers need to understand specific codes, documentation requirements, and reimbursement pathways to bill correctly for patients with alcohol abuse in remission. The right coding will ensure proper payment and help track the patient's recovery progress.

Common CPT codes used with F10.11

The treatment of patients with alcohol abuse in remission ICD 10 code F10.11 uses several procedural codes:

• 90791: Psychiatric diagnostic evaluation

• 90832/90834/90837: Individual psychotherapy (30, 45, or 60 minutes)

• 90853: Group psychotherapy

• 99408: Alcohol screening and brief intervention (15-30 minutes)

• 99409: Alcohol screening and brief intervention (>30 minutes)

• H0001: Alcohol assessment

• H0004: Behavioral health counseling and therapy

Medical providers should choose E/M codes based on whether they focus on screening or treatment. Preventive medicine codes work best for screening, while outpatient E/M codes based on time or key components suit treatment sessions.

DRG groupings and reimbursement categories

F10.11 fits into four Diagnosis Related Groups (MS-DRG v42.0):

• 894: Alcohol/drug abuse/dependence, left against medical advice

• 895: Alcohol/drug abuse/dependence with rehabilitation therapy

• 896: Alcohol/drug abuse/dependence without rehabilitation therapy with MCC

• 897: Alcohol/drug abuse/dependence without rehabilitation therapy without MCC

Medicare Part B covers the ICD 10 code for alcohol abuse in remission in specific settings: office (11), urgent care (20), independent clinic (49), federally qualified health center (50), rural health clinic (72), and independent laboratory (81).

Avoiding claim denials with proper documentation

Healthcare providers can prevent denials for alcoholism in remission ICD 10 claims through several steps.

The diagnostic statements must match ICD-10-CM nomenclature. Medical necessity needs clear documentation with clinical indicators for ordered tests. Providers should include signed face-to-face or telehealth encounter notes with their printed name and credentials.

A treatment plan must exist to show the condition as an active medical problem. This plan can include medication, referral, diet, or monitoring protocols.

Claims might need advance beneficiary notice (ABN) requirements if denied. Medical providers should bill all services from the same day on one claim. They need to add appropriate NCCI modifiers like XE or XU to subsequent codes for presumptive screen and definitive drug tests on the same date.

Conclusion

The ICD 10 code F10.11 for alcohol abuse in remission ended up serving both clinical and administrative purposes in healthcare settings. Proper use of this code will give a clear record of patient history and proper reimbursement. Medical providers should note that F10.11 applies to mild alcohol use disorder in remission, while F10.21 indicates moderate or severe cases in remission.

Documentation is the life-blood of successful coding. Clinical notes should show a clear history of problematic alcohol use and verify the absence of current symptoms with evidence of remission. Knowledge of related CPT codes, DRG groupings, and exclusion notes helps direct you through medical billing complexities.

The difference between early and sustained remission plays a vital role when using code F10.11. Many patients achieve remission without formal treatment, and accurate tracking through proper coding helps verify treatment approaches and recovery patterns. Details matter in your documentation process. A clear remission status, absence of current symptoms, and a full picture of findings prevent claim denials and support quality patient care.

Becoming skilled at F10.11 coding improves reimbursement outcomes and helps track alcohol use disorders better across healthcare systems.

FAQs

What does ICD-10 code F10.11 represent?

ICD-10 code F10.11 represents "Alcohol abuse, in remission." It applies to mild alcohol use disorder that is either in early or sustained remission, indicating a patient has a history of alcohol abuse but is currently not actively drinking or engaging in problematic alcohol use.

How is F10.11 different from F10.10?

F10.11 (Alcohol abuse, in remission) indicates a mild alcohol use disorder that is no longer active, while F10.10 (Alcohol abuse, uncomplicated) represents a current, active mild alcohol use disorder. The key difference lies in the patient's current status of alcohol use.

What documentation is required to use code F10.11?

To use code F10.11, healthcare providers must document a clear history of alcohol abuse, confirm the absence of current symptoms or complications, and provide evidence of maintained remission for a clinically significant period. The documentation must explicitly state the remission status.

Can F10.11 be used alongside codes for alcohol dependence?

No, F10.11 cannot be used alongside codes for alcohol dependence (F10.2-) or alcohol use, unspecified (F10.9-). These are listed as Excludes1 notes, meaning they represent mutually exclusive diagnoses and cannot occur together.

What are some common CPT codes used with F10.11?

Common CPT codes used with F10.11 include 90791 (Psychiatric diagnostic evaluation), 90832/90834/90837 (Individual psychotherapy), 90853 (Group psychotherapy), and 99408/99409 (Alcohol screening and brief intervention). The choice of code depends on the specific treatment or service provided.

References

[1] - https://www.icd10data.com/ICD10CM/Codes/F01-F99/F10-F19/F10-/F10.11

[2] - https://pmc.ncbi.nlm.nih.gov/articles/PMC2835695/