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Coding Of Substance Dependence And Abuse
Alcohol Abuse and Alcohol Dependence (Alcoholism)
ICD-9-CM makes a distinction between alcohol dependence (category 303) and alcohol abuse (305.0X).
Alcohol dependence (alcoholism): 303.XX
Alcohol dependence (alcoholism) is a chronic condition in which the patient has become dependent on alcohol, with increased tolerance, and is unable to stop its use even with such strong incentives as impairment of health, deteri-orated social interactions, and interference with job performance. Such patients often experience physical signs of withdrawal when there is any sudden cessation of drinking.
Alcohol dependence is classified to category 303, Alcohol dependence syndrome. Code 303.0X, Alcohol dependence syndrome, acute alcoholic intoxication is assigned when a patient who is dependent on alcohol and presents for care in a state of acute intoxication. The patient who presents when not acutely intoxicated, as for a rehabilitation program, is classified to 303.9X, Other and unspecified alcohol dependence. Code 303.0X includes both the acute inebriation and the chronic alcoholism. The diagnostic statement of acute and chronic alcoholism should be re-viewed to determine which of these codes is appropriate; only one code should be assigned.
Alcohol abuse: 305.0X
Alcohol abuse represents problem drinking and includes those patients who drink to excess, but have not reached a stage of physical dependency on alcohol. It may include such alcohol-related conditions as temporary mental dis-turbance, slurred speech, blackouts, difficulty in driving, arguments with family and friends, and difficulty in the work environment. Alcohol abuse is classified to code 305.0X, Alcohol abuse. This code includes simple drunken-ness.
Drug Abuse and Dependence
Nondependent use of drugs is classified to category 305; drug dependence is classified to category 304. The fourth digit axis indicates the specific drug or class of drug used; the fifth digit indicates the pattern of use.
Drug dependence (addiction): 304.0X-304.9X
Drug dependence (drug addiction) is a chronic mental and physical condition related to the patient's pattern of tak-ing a drug or combination of drugs. It is characterized by behavioral and physiological responses. These include a compulsion to take the drug, to experience its psychic effects, or avoid the discomfort of its absence. There is in-creased tolerance and an inability to stop the use of the drug even with strong incentives. Such patients often ex-perience physical signs of withdrawal when there is any sudden cessation of drug taking.
Combination codes are provided for drug dependence in which more than one drug is involved. Code 304.7X is assigned when the combination includes an opioid drug; code 304.8X is assigned when the combination does not include an opioid drug.
Drug abuse: 305.1X-305.9X
Drug abuse represents problem drug-taking and includes those patients who take drugs to excess, but have not reached a stage of dependence on the drug(s). It represents the effects of the drug(s) in a maladaptive pattern, which may include detrimental social functioning or physical and/or mental health. It may include drug-related conditions such as temporary mental disturbance, slurred speech, blackouts, difficulty in driving, arguments with family and friends, and difficulty in the work environment. This category includes simple drug intoxication.
Fifth-Digit Subclassification
A fifth-digit subclassification is provided for categories 303-305 to indicate the patient's pattern of use:
0 unspecified
l continuous:
Alcohol: refers to daily intake of large amounts of alcohol or regular heavy drinking on weekends or days off from work
Drugs: daily or almost daily use of drug
2 episodic:
Alcohol: refers to alcoholic binges lasting weeks or months, followed by long periods of sobriety