# Use vs Abuse vs Dependence from an auditing perspective



## bridgettemartin (Sep 2, 2016)

I am seeking an opinion from an auditor.  I posted this in another forum and am wondering what guidance can be offered and if there is a resource out there that addresses this scenario specifically.

We are instructed that whenever more than one classification of drug/alcohol use is mentioned, that we code the higher level. For instance, if abuse and dependence are both mentioned, we code only dependence. That being said, does anyone have a reference that mentions what to do when both are mentioned in the note, but only one is listed under the Assessment or Dx portion of the note? 
For instance---I have a Psychiatric admission note that goes into detail about the patient's dependence and alcohol consumption. But, when the Provider lists the actual admitting dx he states 'Alcohol Use Disorder' which aligns with DSM. I have both listed in the documentation, but he doesn't state dependence under the admitting dx. I have no problem querying the provider, but wondering if since both are mentioned in his documentation, but only 'use' mentioned as the dx, if I would need to.

Much appreciated!


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## danskangel313 (Sep 4, 2016)

This is an old post, but might be helpful for you. https://www.aapc.com/memberarea/forums/101237-help-alcohol-abuse-dependence.html

Because it states "Alcohol abuse represents problem drinking and includes those patients who drink to excess, but have not reached a stage of physical dependency on alcohol", it leads me to believe that if the provider documented a dependency, that would supersede coding for abuse. Although the admitting DX is "Alcohol Use Disorder", I would lean towards alcohol dependency as the code to go with. The exception would be if the documentation indicates a specific reason for admission, such as treating for withdrawal symptoms or treating for an overdose... 

In other words, because alcohol dependency is defined as a _disorder_ or _syndrome_ resulting from (or related to) alcohol abuse, I interpret "Alcohol Use _Disorder_" as dependency.


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## ahguzman (Sep 7, 2016)

Optum ICD10 Expert edition gives this guidance and example

When the provider documentation refers to use, abuse and dependence of the same substance (e.g. alcohol, opioid, cannabis, etc.) only one code should be assigned to identify the pattern of use based on the following hierarchy:

* 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 use, abuse and dependence are all documented, assign only the code for dependence
* IF both use and dependence are documented, assign only the code for dependence 

**History and physical notes cannabis dependence; progress note says cannabis abuse
assign F12.20- Cannabis dependence, uncomplicated**
Explanation:  In the hierarchy, the dependence code is used if both abuse and dependence are documented

Hope this helps.


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