Pediatric Coding Alert

Question: One of our adolescent patients just came in seeking to give up vaping following all of the recent news about the possible dangers of using e-cigarettes. Our pediatrician documented nicotine dependence, but as the patient is vaping and not smoking regular cigarettes, would e-cigarettes be regarded as inhalants? What diagnosis code should I use?

Pennsylvania Subscriber

Answer: Inhalants are defined as regular industrial or household products containing chemicals that are concentrated and inhaled at room temperature for the purpose of intoxication. As this process of concentration does not involve heating or burning, which is essential to the process of cigarette smoking or vaping, inhalants are regarded as a separate category of drug and are coded to their own ICD-10 code group: F18.- (Inhalant related disorders).

Instead, as e-cigarettes use a tobacco-derived liquid that is heated to form smoke that the user inhales, you will use a code from F17.- (Nicotine dependence) to document your patient’s vaping. However, according to AHA Coding Clinic^® for ICD-9-CM/ICD-10-CM (2017 Volume 4, Number 2), you cannot use F17.21- (Nicotine dependence, cigarettes) because, as you correctly note, the patient is not smoking cigarettes.

Instead, you would use F17.29- (Nicotine dependence, other tobacco product) if your pediatrician has documented the patient’s use of e-cigarettes. You will also add the appropriate sixth character to the code.

As the patient was still vaping at the time of the encounter, the patient would not be in remission or withdrawal. So, unless your provider has documented the patient has other nicotine-induced disorders, you would use F17.290 (Nicotine dependence, other tobacco product, uncomplicated) in this particular situation as the Coding Clinic article suggests.