Wiki Coding for Drug Use

[jessica1974]

A little confused as to when catergory 304 (drug dependency) is used and when 305 (non drug dependancy) should be used. If it doesn't state that a patient is dependent on the drug would the catergory of 305 be used? I understand the 5th digit of unspecified, continous etc. Just want to be sure that I am using the correct dx code. I can't really find where it's laid out as to which dx code a patient would belong to. Most of our documentation doesn't specify whether the patient is dependant or not. I work for a cardiologist.
Thanks for the help.

 

[sullivak]

I was always taught to never assume that it's dependence unless the physician explicitly states dependence, or alcoholism - something that clearly indicates that it is dependence. In that case, you should just code the abuse 305. I could not find this explicitly stated anywhere in the ICD-9 guidelines, however.

But at least we do have good guidance in ICD-10 (page 10 of the 2013 ICD-10-CM Draft). Here's its take -

When the provider documentation refers to use, abuse and dependence of the same substance (e.g. alcohol, opioid, cannabis, etc.), only one code should be assigned to identify the pattern of use based on the following hierarchy:
- If both use and abuse are documented, assign only the code for abuse
- If both abuse and dependence are documented, assign only the code for dependence
- If use, abuse and dependence are all documented, assign only the code for dependence
- If both use and dependence are documented, assign only the code for dependence.

 

[jessica1974]

Thanks Kim. I thought I should be using the 305 codes. But it doesn't hurt to be sure.

 

[Kisalyn]

Thanks for your question about this. For lack of a dependency statement, I use the category 305 codes too, but always see the hospital coders use 303.XX (for alcohol use). Made me curious. I'm assuming they have access to the whole chart whereas we only have the single documentation to code for our docs.

 

[MnTwins29]

There could be other documentation issues that would explain the difference in these codes. If the hospital coder sees in the progress notes from the physician that the patient has a history of binge drinking, progressively more frequent drinking or other similar behaviors that show a pattern of alcholism, then the 303 series would be appropriate. If your progress notes are only describing the current alcohol use, then yes, 305 would be appropriate.