ED Coding and Reimbursement Alert

The upcoming edition of ICD-10 will offer several new options for patients who have substance abuse issues.

Emergency departments nationwide are getting to know the new ICD-10 codes that will impact claims effective Oct. 1, and while you're reviewing the codes most applicable to your ED, don't forget about the substance abuse diagnoses, which will get a bit of a makeover when the latest ICD-10 edition takes effect.

The changes to these codes provide "clarity in guidance for using existing codes," explains Jan Blanchard, CPC, CPMA, consultant at Vermont-based PCC.

ICD-10 Substance Use Dx Adds Detail

The new ICD-10 edition puts a lot more detail into the code set F10-F19 (Mental and behavioral disorders due to psychoactive substance use) - both in the form of expanded descriptors and new codes.

"The addition of the new ICD-10 codes within Chapter 5 [F10-F19] will allow coders to choose more specific alcohol, drug, and tobacco abuse codes pertaining to state of remission," reports Yvonne Dillon, CPC, CEDC, director of emergency department services at Bill Dunbar and Associates, LLC in Indianapolis, Indiana.

Cynthia A. Swanson, RN, CPC, CEMC, CHC, CPMA, senior manager of healthcare consulting for Seim Johnson in Omaha, Nebraska, agrees, further explains that "the addition of the 2018 ICD-10-CM code revisions continue to enhance proper diagnosis coding by incorporating greater clinical details and specificity. Terminology and disease classification updates are more consistent with current clinical practice," she says.

"Additionally, the updates allow for better data collection and accuracy of patient information," relays Swanson.

New codes:  In 2018, the new codes you'll want to note will include the following:

• F10.11, Alcohol abuse, in remission
• F11.11, Opioid abuse, in remission
• F12.11, Cannabis abuse, in remission
• F13.11, Sedative, hypnotic or anxiolytic abuse, in remission
• F14.11, Cocaine abuse, in remission
• F15.11, Other stimulant abuse, in remission
• F16.11, Hallucinogen abuse, in remission
• F18.11, Inhalant abuse, in remission
• F19.11, Other psychoactive substance abuse, in remission

Impact:  You'll now be able to more accurately pinpoint the stage of the patient's substance abuse and recovery. This will give coders yet another tool in the fight to keep their patients' progress toward recovery on track, says Swanson.

"The new codes will provide greater specificity and clinical accuracy of the patient's diagnosis," she says.

Example: A patient presents to your ED complaining of swelling in her legs, nausea, a decreased appetite, and dizziness. The patient reports that she previously drank eight beers per night but stopped drinking "a while ago" and has felt great ever since she went to rehab. The physician runs tests and determines that the patient is suffering from a marked decrease in liver function. The patient is admitted to the hospital's hepatology unit. The ED physician reports the ICD-10 code for the abnormal liver function and can also choose to report a code such as F10.11 to demonstrate that the patient is in remission from alcohol abuse. This shows the potential cause of the decreased liver function.

Enhanced Descriptors Grace Several Existing Codes

Again, in the F10-F19 section of ICD-10 2018, you'll find expanded descriptors for many codes. As is the case with new codes, these descriptors will help you pinpoint the location of your patients' abuse issues.

Example: While the F13.21 (Sedative, hypnotic or anxiolytic dependence, in remission) code has not changed on the surface, notes below it will read thusly in 2018:

• Sedative, hypnotic or anxiolytic use disorder, moderate, in early remission
• Sedative, hypnotic or anxiolytic use disorder, moderate, in sustained remission
• Sedative, hypnotic or anxiolytic use disorder, severe, in early remission
• Sedative, hypnotic or anxiolytic use disorder, severe, in sustained remission

In 2017, there were no notes below F13.21, leaving coders at a loss to explain:

• The severity of the patient's disorder and
• The patient's remission status.

There will also be similarly expanded code descriptors for many codes in the F10-F19 set, allowing you to paint a better picture of your patients struggling with substance abuse.

Resource: For an in-depth look at the new ICD-10 codes that impact emergency departments, read our overview in Vol. 20, No. 8 of Emergency Department Coding and Reimbursement Alert. To review the government's complete listing of new, revised, and deleted ICD-10 codes, visit https://www.cms.gov/Medicare/Coding/ICD10/2018-ICD-10-CM-and-GEMs.html.