Part B Insider (Multispecialty) Coding Alert

You may have to drill down to manifestations to find the code that suits your patient.

Get ready to change your mindset when choosing a diagnosis code for substance use, abuse, or dependence under ICD-10. Current ICD-9 codes focus on the patterns of use (episodic, continuous, or unspecified), but you'll need to define acute or chronic use to pinpoint the right code under ICD-10.

ICD-9: Sub-Par Documentation Could Trap You in 'Unspecified'

ICD-9 does not clearly define the terms "episodic" or "continuous" use, although you have fifth-digit subclassification choices for use that is unspecified, episodic, continuous, or in remission. Not having clearly defined parameters means providers might not adequately document the situation" which relegates you to the "unspecified" fifth digit of 0.

Example: The physician diagnoses opioid dependence in the patient. Your code choices are:

• 304.00 -- Opioid type dependence; unspecified use
• 304.01 -- ... continuous use
• 304.02 -- ... episodic use
• 304.09 -- ... in remission.

ICD-10: Look for 'Abuse' vs 'Dependence' vs 'Unspecified'

ICD-10 has a clearer classification for the substance use and abuse codes. Begin by asking if the disorder (whether acute or chronic) results from longer-term use.

If the patient doesn't have a current, acute manifestation of the use or abuse, you'll code his condition as "uncomplicated." For example, you might choose F11.10 (Opioid abuse, uncomplicated) or F11.20 (Opioid dependence, uncomplicated) to describe opioid abuse or dependence.

Key: The clinician will document abuse or dependence according to clear parameters of clinical examination and medical history. If you don't have documentation of either abuse or dependence, you'll classify the condition as unspecified, with a code such as F11.90 (Opioid use, unspecified, uncomplicated).

If you look at the extended ICD-10 bridge for 304.00, you'll find more than 10 ICD-10 codes. Table 1 lists the ICD-10 codes that the current code 304.00 spans to.

Manifestations of intoxication and withdrawal: If the provider documents manifestations like delirium or withdrawal symptoms associated with abuse or dependence, you currently have separate codes choices under ICD-9. With ICD-10, however, you can report a single code to capture the conditions. Table 2 illustrates the intoxication and delirium options in ICD-10 and the corresponding existing codes in ICD-9.

The same holds true for reporting of chronic problems due to substance use.

Example: If you need to report insomnia due to opioid dependence, you would report both 292.85 (Drug induced sleep disorders) and 304.00 as the secondary diagnosis code in ICD-9. In ICD-10, you'll turn to the single, more specific code F11.282 (Opioid dependence with opioid-induced sleep disorder).

For the DSM-IV definitions and criteria of abuse and dependence, please read more on http://www.sis.indiana.edu/DSM-IV-Criteria.aspx. http://www.who.int/substance_abuse/terminology/abuse/en/index.html.