Correctly report ICD-10-CM alcohol and drug-related disorders

By Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I

When a patient is diagnosed with an alcohol- or drug-related disorder, the diagnosis is often more complex, as these conditions are susceptible to both psychological and physiological signs, symptoms, manifestations, and comorbidities.

ICD-10-CM provides many more combination codes for these diagnoses, which could actually result in less work for coders.

Below is a comparison of current ICD-9-CM codes with the equivalent ICD-10-CM codes.

The first thing you might notice is that ICD-10-CM couples the abuse and dependence codes, rather than locating them in separate code categories. ICD-10-CM includes codes to specifically report the “use” of alcohol and drugs. That will allow providers to track patient behavior that often will ultimately have a negative impact on the patient’s health.  These details can provide researchers with useful information as they look for better ways to care for patients with addiction.

All of the above codes, in both ICD-9-CM and ICD-10-CM, require additional characters to identify details from the documentation about manifestations and comorbidities. Let’s take alcohol abuse as an example of what details may need to be abstracted from the clinical documentation.

 Alcohol use, abuse, and dependence

The ICD-9-CM code category 305.0x (alcohol abuse) corresponds with ICD-10-CM category F10.1-, but the subcategory specifications are different.

In ICD-9-CM, you have three choices in addition to an unspecified option:

• 305.01, alcohol abuse, continuous
• 305.02, alcohol abuse, episodic
• 305.03, alcohol abuse, in remission

In ICD-10-CM, you will have these specific options, as well as unspecified choices in each category:

• F10.10, alcohol abuse, uncomplicated
• F10.120, alcohol abuse with intoxication, uncomplicated
•  F10.121, alcohol abuse with intoxication delirium
• F10.14, alcohol abuse with alcohol-induced mood disorder
• F10.150, alcohol abuse with alcohol-induced psychotic disorder with delusions
•  F10.151, alcohol abuse with alcohol-induced psychotic disorder with hallucinations

F10.180, alcohol abuse with alcohol-induced anxiety disorder

F10.181, alcohol abuse with alcohol-induced sexual dysfunction

F10.182, alcohol abuse with alcohol-induced sleep disorder

F10.188, alcohol abuse with other alcohol-induced disorder

You can see the required details change significantly. In ICD-9-CM, the details focused more on a timeline of the patient’s use of the alcohol or drug involved, whereas ICD-10-CM requires a deeper understanding of the psychological and behavioral impact of the abuse or dependence. You will report signs, symptoms, manifestations, and comorbidities such as delirium, mood disorder, and hallucinations with one combination code from this subsection instead of needing to look for a second code.

In the subcategories for alcohol use and dependence, you will also find codes for states such as withdrawal, again providing one combination code, rather than needing a second code to report this condition. For example:

 Other non-therapeutic substances

The extended descriptions and combination code choices include codes used to report the use of other non-therapeutic substances, such as hallucinogens, caffeine, and inhalants.

ICD-10-CM code descriptions separate inhalant abuse and dependence into their own specific code category (F18.-).Caffeine remains included in the “Other” code category, now combined with amphetamine-related disorders.

Though it varies by code,  additional characters required for these ICD-10-CM codes will include searching documentation for details on  accompanying conditions such as:

• Intoxication
• Delirium
• Perceptual disturbance
• Mood disorder
• Psychotic disorder with delusions or hallucinations
• Anxiety disorder
• Flashbacks

 Nicotine dependence

One more addition to this subsection of the Mental and Behavioral Disorders chapter of ICD-10-CM is code category F17.- (nicotine dependence), which again goes into much further detail than ICD-9-CM codes 305.10-305.13.

The Excludes1 note reminds you that this is not the same diagnosis as tobacco use (Z72.0) nor history of tobacco dependence (Z87.891). Therefore, the documentation will need to specifically discern between tobacco use and nicotine dependence.

ICD-10-CM classifies nicotine dependence by substance:

• F17.20, nicotine dependence, unspecified
•  F17.21, nicotine dependence, cigarettes
• F17.22, nicotine dependence, chewing tobacco
• F17.29, nicotine dependence, other tobacco product

Each category further breaks down the dependence using a sixth character to denote:

• Uncomplicated (0)
• In remission (1)
• With withdrawal (3)
• With other nicotine-induced disorders (8)

Use, abuse, and dependence guidelines

In some cases, physicians may document a combination of use, abuse, and dependence of the same substance. ICD-10-CM includes the following hierarchy to follow in those situations:

• If both use and abuse are documented, assign only the code for abuse
• If both abuse and dependence are documented, assign only the code for dependence
• If both use and dependence are documented, assign only the code for dependence
• If use, abuse, and dependence are all documented, assign the code for dependence

The bottom line is that ICD-10-CM has reorganized these codes in a more logical and efficient order and provided you with many more combination codes, thereby reducing your work.

Editor’s note: Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, of Safian Communications Services in Orlando, Fla., is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee. Email her at ssafian@embarqmail.com.