Wiki Long-term use of Suboxone diagnosis

[Bernadette10]

Would long-term use of Suboxone be coded as opioid dependence, F11.20? I thought if someone was taking this, they were still dependent on opioids. The provider states both opioid dependence in remission and opioid abuse.

Patient has been on Suboxone on and off for approx 1 year, taking 8 2 mg bid. He says he has been trying to stay away from substances. He has not used any other opioids. He has used methamphetamine, though, almost daily. Discussed that he will need to stop using meth by a specific date to continue receiving Suboxone.

Exam:
Appears stated age, NAD.
Heart regular rate and rhythm.
Lungs clear to auscultation.

Assessment/Plan
Opioid dependence in remission, opioid abuse.
Methamphetamine abuse.
Refilled Suboxone 8 2 mg film, medication-assisted treatment. Monitor urine drug screen. Follow up in 2 weeks. Get urine test done here 2-7 days before next visit in 2 weeks.

 

[thomas7331]

This question is addressed in the ICD-10 guidelines - see section I.C.21.c.3, under the instructions for the use of the Z79 codes: Codes from this category indicate a patient’s continuous use of a prescribed drug (including such things as aspirin therapy) for the long-term treatment of a condition or for prophylactic use. It is not for use for patients who have addictions to drugs. This subcategory is not for use of medications for detoxification or maintenance programs to prevent withdrawal symptoms (e.g., methadone maintenance for opiate dependence). Assign the appropriate code for the drug use, abuse, or dependence instead.

 

[Bernadette10]

Thanks, so just to clarify, the provider's statement of opioid dependence in remission wouldn't be correct since the patient is still taking an opioid, and his statement of opioid abuse is what should be coded? Providers say conflicting things with for this diagnosis often.

 

[thomas7331]

Thanks, so just to clarify, the provider's statement of opioid dependence in remission wouldn't be correct since the patient is still taking an opioid, and his statement of opioid abuse is what should be coded? Providers say conflicting things with for this diagnosis often.

Providers do say conflicting things and that appears to be the case here. Personally, I would query the provider for clarification since, as you said in the original post, the fact that the patient is taking Suboxone suggests that the patient is still dependent rather than being in remission. If in fact they are in remission, then yes, I would code the abuse since that is an active diagnosis.