# how to code "narcotic tolerance"



## diane1217 (Nov 29, 2011)

Anyone know the correct ICD-9 for "narcotic tolerance"? I can only find 304.00, but don't want to imply dependence if that is not specifically documented. 

Thanx for ANY help........

Diane


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## hewitt (Nov 29, 2011)

The 305 series of ICD-9s are non dependent.... Maybe you can find what you need there.


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## diane1217 (Nov 29, 2011)

305 category is all for abuse. This is simply a person taking high dose narcotics as prescribed, no abuse, and dependency is not documented. Just need to show the pt's tolerance of narcotics to justify their need for anesthesia for an injection that doesn't normally require anesthesia.


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## hewitt (Nov 29, 2011)

Thank you for the additional information! Your first note suggested that dependence was to be avoided.... Will pursue narcotic prescribed for therapeutic use and let you know what I find.


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## mhstrauss (Nov 29, 2011)

Not sure if this will fit what you need, but just a suggestion to throw out there... V58.69- long-term (current) use of other medications

This is what we use for our pain management drug screens...might work for what you need.


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## Tonyj (Nov 29, 2011)

mhstrauss said:


> Not sure if this will fit what you need, but just a suggestion to throw out there... V58.69- long-term (current) use of other medications
> 
> This is what we use for our pain management drug screens...might work for what you need.



That would not fit their needs. It's for long term use. Good question though, I'm alittle at odds.


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## ajs (Nov 29, 2011)

diane1217 said:


> 305 category is all for abuse. This is simply a person taking high dose narcotics as prescribed, no abuse, and dependency is not documented. Just need to show the pt's tolerance of narcotics to justify their need for anesthesia for an injection that doesn't normally require anesthesia.



Interestingly, if a person develops a "tolerance" for narcotics it is generally due to "long term" use.  
The only code that fits your scenario is V58.69 Long term (current) use of other medications.  Under that the description states:

                 "Other high-risk medications
                    Long term current use of methadone for pain control
                    Long term current use of other opiate analgesic"

If the patient is currently using other narcotic medications and has been doing so for a while, this would seem to fit.


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## mitchellde (Nov 29, 2011)

ajs said:


> Interestingly, if a person develops a "tolerance" for narcotics it is generally due to "long term" use.
> The only code that fits your scenario is V58.69 Long term (current) use of other medications.  Under that the description states:
> 
> "Other high-risk medications
> ...


Not necessarily, I have narcotic tolerance and have never been on long term narcotics.  It just means for me anyway that I have a high tolerance for the effects of narcotics and it takes a lot to put me under and keep me under.   To my knowledge there is no way to code for this with a dx code.  You will probably need to work this one on claim submission with a physician letter explaining the nature of the tolerance and why the procedure needed the anesthesia it needed.


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## hewitt (Nov 30, 2011)

There is nothing in the coding regulations that says it cannot be coded as an adverse reaction. In the case of the anesthesia example, I would consider using 995.22, and generally speaking, would consider 995.29 as an option.


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## mitchellde (Nov 30, 2011)

But it is not an adverse reaction.  It is not a reaction at all it is just the patient's metabolism.  There just is no code for this.


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