Primary Care Coding Alert

And learn these 9 new codes to report drug and alcohol remission.

Recently, the Centers for Disease Control and Prevention (CDC) posted a list of almost 1,500 ICD-10 2023 changes scheduled to take effect Oct. 1, 2022. Among those changes are more specific ways to report grief and stress as well as past and present drug and alcohol use.

Here’s a breakdown of the codes and why they matter.

Capture Patient Mental Health More Thoroughly

Primary care practitioners (PCPs) play a big role in mental healthcare. PCPs are often the first point of contact for people who aren’t feeling well mentally or physically. “Many reports during the pandemic showed patients having extended levels of grief due to isolation, inability to gather for funerals, and so on,” 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.

The new codes you need to know are:

• F43.81 (Prolonged grief disorder)
• F43.89 (Other reactions to severe stress)

ICD-10 currently offers you only F43.8 (Other reactions to severe stress), which is inclusive of “Other specified trauma and stressor-related disorder.” The change makes F43.8- the parent code, with fifth characters 1 and 8 allowing for more specificity. “Having this specific section get more definitive coding is reassuring to see,” says Maureen Leahey, CHC, CPC, primary care coding team leader with Sentara Healthcare in Norfolk, Virginia. “This area of coding as it relates to stress certainly needs more attention since stress can lead to so many more clinical issues, whether chronic condition(s), autoimmune disorders, or both,” Leahey adds.

Depend on These Codes for Drug and Alcohol Use Specificity

Next, you can expect to see other code families impacted by the 2023 changes, including these new F10.- to F19.-:

• 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)

The most noticeable change here is the addition of specific drugs, as well as the assignment of “in remission” to alcohol and drug use, rather than abuse or dependence. Each of the code families referenced above currently include remission codes, but only in the case of abuse (F--.11) or dependence (F--.21). For instance, in the F10.- family there is F10.11 (Alcohol abuse, in remission) and F10.21 (Alcohol dependence, in remission), and in the F19 family, there is F19.11 (Other psychoactive substance abuse, in remission) or F19.21 (Other psychoactive substance dependence, in remission).

For the 2023 code set, reporting is based on clinical judgment and thorough documentation as before, but the ability to code specific drug and alcohol use (rather than abuse or dependence) in remission allows you to communicate past use easier than you could previously because there’s no need to clinically establish abuse or dependence first. This could be particularly helpful for a new physician who may not be able to determine a patient’s precise level of dependence, abuse, or use, or a new patient who hasn’t yet disclosed much about their past drug or alcohol use.