Coding Substance Use, Abuse, and Dependence: ICD-9 and ICD-10 Differences – Part 3

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drinksThis is Part 3 of our series on the differences between ICD-9 and ICD-10 in coding substance use, abuse, and dependence. Today’s article will focus on combination codes. Check out Part 1 for information on guidelines and hierarchies and Part 2 for the differences between codes available in ICD-9 and ICD-10 for reporting use, abuse, and dependence.

In Part 2 of this series it was mentioned that the new, individual code categories in ICD-10 for nicotine dependence and alcohol and psychoactive substance related disorders help ICD-10 provide greater specificity than is4 found in ICD-9. In addition to the use of individual categories, specificity in this section of ICD-10-CM is enhanced through the use of combination codes that report the substance (e.g., cocaine), the pattern of consumption (e.g., abuse), and various other factors such as the current state of the condition (e.g., in withdrawal) and/or the presence or absence of mental disorders induced by use of the substance (e.g., with delirium).

The availability of combination codes that report mental disorders associated with the use of nicotine, alcohol, or psychoactive substances is important because codes that report the pattern of use as “use, unspecified” are only assigned when the record documents that the patient is using the substance but has not specified the use as either abuse or dependence and the use is associated with a mental or behavioral disorder and the relationship is documented by the provider (Guideline 5.b.3).

Here’s a look at combination codes by substance.

Alcohol
Current state of the condition: Category F10 is divided into 3 subcategories based on pattern of use: use, abuse, and dependence. Depending on the subcategory, options are available to report the possible current state of the condition.

  • Use: with intoxication
  • Abuse: uncomplicated, with intoxication
  • Dependence:  uncomplicated, with intoxication,  with withdrawal, in remission

Associated mental disorders: Depending on the subcategory and the pattern of use, the state of the condition can be reported as uncomplicated or complicated by certain associated mental disorders, which may include:

  • Delirium
  • Mood disorder
  • Psychotic disorder with delusions
  • Psychotic disorder with hallucinations
  • Persisting amnestic disorder
  • Persisting dementia
  • Anxiety disorder
  • Sexual dysfunction
  • Sleep disorder
  • Perceptual disturbance
  • Other/Unspecified

Tobacco (Nicotine)
Dependence by product: Category F17 is divided into only one subcategory based on pattern of use: dependence. This subcategory is further divided by tobacco product:

  • Cigarettes
  • Chewing tobacco
  • Other tobacco product
  • Unspecified

Current state of the condition: Category F17 has option 5 available to report the possible current state of the condition.

  • Uncomplicated
  • In remission
  • With withdrawal

Nicotine induced disorders: Category F17 does not have codes for specific mental disorders. Beyond pattern of use and current state of the condition additional subdivisions of specificity include:

  • With other nicotine induced disorder
  • With unspecified nicotine induced disorder

Psychoactive Substances
Codes that report the consumption of psychoactive substances, other than tobacco or alcohol, are divided into 8 categories by substance. Each is further subdivided by pattern of use. The 8 categories include:

  • Opioid related disorders (F11)
  • Cannabis related disorders (F12)
  • Sedative, hypnotic, or anxiolytic disorders (F13)
  • Cocaine related disorders (F14)
  • Other stimulant related disorders (F15)
  • Hallucinogen related disorders (F16)
  • Inhalant related disorders (F18)
  • Other psychoactive substance related disorders (F19)

Current state of the condition: Categories F11-16, F18-F19 can have up to option 5 available to report the possible current state of the condition.

  • Use: uncomplicated, with intoxication, with withdrawal (Categories F11, F13, F15, F19 only)
  • Abuse: uncomplicated, with intoxication
  • Dependence: uncomplicated, in remission, with intoxication, with withdrawal (Categories F11, F13, F14, F15, F19 only)

Associated mental disorders: For each of the categories F11-16, F18-F19 (depending on the subcategory) the pattern of use and the state of the condition can be reported as uncomplicated or complicated by certain associated mental disorders, which may include:

  • Delirium
  • Mood disorder
  • Psychotic disorder with delusions
  • Psychotic disorder with hallucinations
  • Persisting amnestic disorder
  • Persisting dementia
  • Anxiety disorder
  • Sexual dysfunction
  • Sleep disorder
  • Perceptual disturbance
  • Other/Unspecified

In comparison with ICD-9, the specificity of data made possible with the combination codes available in ICD-10 for reporting use, abuse, and dependence provides a much more complete and accurate clinical picture of the patient’s condition. This expanded clinical picture is critical in supporting resource consumption and choice validation of various treatment options.

So there you go! That wraps up our series on the differences between substance use, abuse, and dependence coding in ICD-9 and ICD-10. Certified medical coders are advised to also check out Part 1 for information on guidelines and hierarchies and Part 2 for the differences between codes available in ICD-9 and ICD-10 for reporting use, abuse, and dependence.


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