Primary Care Coding Alert

Test your memory of some recent major ICD-10 updates.

Whether you’re a new or seasoned coder, it can be challenging to keep up with all the coding updates that have been handed out lately. Among these updates are more than 1,000 new ICD-10 codes, many of which have a direct impact on primary care coders like you.

That’s a lot to keep straight, so we’ve compiled answers to a few common questions surrounding significant additions to ICD-10 to help you feel confident heading into 2023.

What’s So Different About the New Drug and Alcohol Codes?

Answer: There are two main differences that affect the F10.- to F19.- codes. The first is the addition of codes that represent a patient’s drug or alcohol use in remission. The previous code set allowed you to report remission, but only for patients who have a proven history of drug or alcohol abuse or dependence. The second is the ability now to report this remission status in relation to use of more specific categories of drugs. Now, you’re able to code remission for patients who have used alcohol, opioids, cannabis, sedatives, hypnotics, anxiolytics, cocaine, hallucinogens, or inhalants, as well as “other” stimulants and “other” psychoactive substances:

• F10.90 (Alcohol use, unspecified, uncomplicated)
• F10.91 (Alcohol use, unspecified, in remission)
• F11.91 (Opioid use, unspecified, in remission)
• F12.91 (Cannabis use, unspecified, in remission)
• F13.91 (Sedative, hypnotic or anxiolytic use, unspecified, in remission)
• F14.91 (Cocaine use, unspecified, in remission)
• F15.91 (Other stimulant use, unspecified, in remission)
• F16.91 (Hallucinogen use, unspecified, in remission)
• F18.91 (Inhalant use, unspecified, in remission)
• F19.91 (Other psycho­active substance use, unspecified, in remission)

Documentation alert: Like before, clinical judgment and thorough documentation will dictate which codes you submit. However, the expansion of this code set to include substance use in remission allows your provider the opportunity to include important drug and alcohol details in a patient record without the provider first having to clinically establish the patient’s substance abuse or dependence.

From a patient well-being standpoint, you want to have substance use information as soon as possible in case the patient needs prescription medication. “It’s important for a physician to acknowledge past drug use in order to help a patient maintain their sobriety,” says Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California.

Note: There is one new code that isn’t about remission, and that’s F10.90 (Alcohol use, unspecified, uncomplicated). The addition of F10.90 allows you to code unspecified alcohol use without having to make the leap to F10.92- (Alcohol use, unspecified with intoxication), F10.93- (Alcohol use, unspecified with withdrawal), or a series of other codes that describe alcohol use with related disorders.

Why Are the New Z79.- Codes Important?

Answer: Submitting Z79.- (Long term (current) drug therapy) codes could affect how you level encounters using medical decision making (MDM).

How: While a lot of factors go into MDM, Z79.- codes play an important role in helping to justify moderate and high MDM levels of an E/M visit. The Z codes in general, as defined by ICD-10 Official Guidelines, Section I.B.19.d, “may be assigned as appropriate to further explain the reasons for presenting for healthcare services, including transfers between healthcare facilities, or provide additional information relevant to a patient encounter.” They are essentially used as supporting details.

In the Levels of MDM table in CPT^®, “Prescription drug management” is an example of moderate risk of morbidity from additional diagnostic testing or treatment, while “Drug therapy requiring intensive monitoring for toxicity” is an example of high risk. The Z79.- codes your documentation supports may play a role in determining the complexity of the MDM involved in the patient’s care by establishing, at a minimum, that an encounter involves prescription drug management. Depending on the drug therapy described by the Z79.- code, it may further help establish that patient’s drug therapy requires intensive monitoring for toxicity. Here are the new codes:

• Z79.6- (Long term (current) use of immunomodulators and immunosuppressants),
• Z79.60 (Long term (current) use of unspecified immunomodulators and immunosuppressants)
• Z79.61 (Long term (current) use of immunomodulator)
• Z79.62- (Long term (current) use of immunosuppressant)
• Z79.63- (Long term (current) use of chemotherapeutic agent)
• Z79.64 (Long term (current) use of myelosuppressive agent)
• Z79.69 (Long term (current) use of other immunomodulators and immunosuppressants)
• Z79.85 (Long-term (current) use of injectable non-insulin antidiabetic drugs)

Note that Z79.62- and Z79.63- also break down into more specific drug codes.

Example: Chemotherapy, and the cancer itself, can be enough to bump an E/M service potentially to 99215 (Office or other outpatient visit for the evaluation and management of an established patient … high level …). That’s because drug therapy requiring intensive monitoring for toxicity is an example of the high risk of complications of patient management element of MDM, while the patient’s condition may also rise to the high level of number and complexity of problems addressed element of MDM. So, reporting a code such as Z79.63 may support the higher-level E/M. While it’s true that an oncologist is usually the one to test for drug toxicity, it’s not uncommon for a rural chemotherapy patient to check in with their PCP for such tests in between trips to their chemotherapy center.