Wiki Drug USE vs. ABUSE

[pookergirl]

This is driving me nuts. Hoping to get some input. When would we ever use a drug USE code? Why would there be a cannabis use code if we aren't allowed to use it? For example patient takes multiple marijuana gummies, develops anxiety and chest pain, goes to the ER and provider's final diagnoses are marijuana use, anxiety, chest pain, according to the guidelines we can't code the cannabis use at all is what I'm being told. I was told to remove the physician's #1 diagnosis of marijuana use, and I just keep questioning why? When it's integral to the reason for visit. And on another one, the provider's diagnosis was marijuana use with intoxication and there is a code for that, but I was told to change it to marijuana abuse with intoxication, even though that wasn't provider's final diagnosis. Where does it say if you only have 'use' you must change it to abuse? The guidelines state if you have use and abuse, then you code abuse. It says nothing about not being able to code use when it's the given diagnosis. I assumed the guideline about not coding use means if it's mentioned anywhere the patient uses a drug, don't pick it up, like don't pick it up from the PMH, etc. Help me understand!

 

[TThivierge]

Pookergirl
I think it is because of 2 reasons.....#1 Most healthcare insurance not wanting to cover beh. health issues of sub abuse drugs and alcohol. This maybe the rational put it level 4 or 5 listed dx code on claim. The insurance companies algorithms would link it with denial if coded as first dx or lessen payment. These days many insurance commercial business lessening drug abuse coverage or none at all. And #2 some therapist do not want to link sub abuse behavior with patient because listed in health record over their life time. But it is what it is....you as medical coder follow the national coding rules by assigning what provider states but follow what your employer tells you. Ensure it is email telling you this ..most coders get audited every 90 days. Defining "use" vs " abuse" & "dependence" means...addiction. Where as "use" is just use it once in awhile /recreational. There is a difference in remission vs history too in coding sub abuse problems.
I hope helped you
Lady T