So this topic is a little tricky. There is no specific guidance about tobacco use vs dependence, but this is what I know has to be applied, and the way we do it in our facility.
1. Anytime the provider documents patient is "smoker" you automatically code it as tobacco dependence. If you go to the index, under "smoker" it will guide you to dependence.
2. If they document patient smokes regularly, or tobacco use, or tobacco use: occasional, that falls under tobacco use as the patient won't required any sort of treatment like nicotine patch so its coded to Z72.0
3. I read an article from AHIMA that stated to code tobacco use as dependence only when specifically stated as "dependence" following the guideline for substance use under Chapter 5 ICD-10-CM
4. An article from AAPC states you could code dependence even if no "dependence" is documented, as long as they document "patient smokes 2 packs of cigarettes per day" just by saying how much he smokes.
5. The guidance we follow here in our facility is, if they say smoker, thats 100% dependence. If they only document "patient smokes 1 pack per day" then we code it to tobacco use Z72.0 as they are not specifying "Dependence." If they state patient is heavy tobacco user, requires nicotine patch or gum, and is provided counseling or some type of assessment to help him stop smoking, then with all that supporting documentation, we go with dependence.
Keep in mind this is just based on our facility coding plan, there is really nothing on writing stating its right, but it's the closes to coding accurate smoking use.
Hope this helps!