Wiki Tobacco Use Vs Tobacco Dependence - Can anyone explain

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AmandaHartman

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Hi -
Can anyone explain t me what the difference between Tobacco Use (Z72.0) and
Tobacco Dependence (F17.-) is in ICD-10.
I am not understanding the specific difference or definition. What would the physician need to specifically document for either?
 
Physicians diagnose dependence based on specific criteria (see DSM-V). Dependence should be reported when that is the physician's documented diagnosis. Tobacco use would be reported when use is documented but not dependence.
 
The statement ": patient smokes" or "Patient smokes occasionally" or "Patient is a social smoker" is tobacco use
"Patient smoke 2 packs per day" or "patient has a 40 pack year habit" is nicotine dependence
 
Hi, I'm confused on this as well. I was under the same impression as the other respondees, that it would be coded as "use" unless the provider expressly calls it "dependence" or "abuse". However, the 3M ICD-10 Training Modules do not follow that philosophy. They note that the term "smoker" in the ICD-10 alpha index directs you to " nicotine dependence", not to "tobacco use". This was reinforced in two test questions within the 3M Training which indicated documentation of "cigarette smoking" is coded as "nicotine dependence", even if the provider doesn't refer to it as such. However, another test question was in regards to an "occasional smoker". For this one, it coded to "tobacco use". However, I don't understand this and am still unable to locate the portion of the official ICD-10 Guidelines that explains this. Hope this info is helpful somewhat, and if you locate clear guidance, please share it with me. Thank you!
 
mental& behavioral disorders due to psychoactive substance use

chapter 5: mental, behavioral and neurodevelopmental disorders (F01-F99)

**When the provider documentation refers to use, abuse and dependence of the same substance( eg, alcohol, opioid, cannabis, etc.), only one code should be assigned to identify the pattern based on hierarchy:

1. If both use and abuse are documented, assign only the code for abuse
2. If both abuse and dependence are documented, assign only the code for dependence
3. If both use and dependence are documented, assign only the code for dependence
4. If use, abuse, and dependence are all documented, assign the code for dependence.


Hope this help. This is the guideline straight from the ICD-10 training book.
 
Tobacco Use Vs Nicotine Dependence In ICD-10

Although benaxixon's reference to the chapter 5 guidelines is very informative, is doesn't really answer the question of why the Tobacco Use Z72.0 even exists and when it would be used. Note that under F17 (Nicotine) there is no breakdown of Abuse, vs Dependence vs Use as there is for other psychoactive drugs, i.e. inhalants, Hallucinogens, Stimulants. Under Nicotine dependence (F17), it's a matter of dependence only, with the choice of uncomplicated, in remission, with withdrawal, with other nicotine-induced disorders, with unspecified nicotine-induced disorders. It's still not clear when we would use a code from the Mental and Behavioral Disorder category (F17) vs a much more benign code from the Z category. I've never seen a provider document Nicotine Dependence, however all of our notes ask if the patient smokes, and how much. I would think I'd use the Tobacco Use (Z72.0) code unless the patient is trying to stop smoking and reports withdrawal, or other nicotine-induced disorders. Thoughts?
 
When I worked at the Cancer research center way before ICD-10 was a reality, the doctors there stated that if it is documented as a packs per day or pack year habit then it is the physicians way of indicating a dependency to a certain extent and if they document just uses or social use then it is not be documented as a dependenc. To hav a habit documented as so many packs is indicating that the patient is dependent on that many cigarets to get them thru an average day. Based on this being a physician definition I have always gone with it.
 
benaxixon said:
chapter 5: mental, behavioral and neurodevelopmental disorders (F01-F99)

**When the provider documentation refers to use, abuse and dependence of the same substance( eg, alcohol, opioid, cannabis, etc.), only one code should be assigned to identify the pattern based on hierarchy:

1. If both use and abuse are documented, assign only the code for abuse
2. If both abuse and dependence are documented, assign only the code for dependence
3. If both use and dependence are documented, assign only the code for dependence
4. If use, abuse, and dependence are all documented, assign the code for dependence.


Hope this help. This is the guideline straight from the ICD-10 training book.
Click to expand...

I'm gonna add to this discussion.

What would you code if only use was documented. No mention of abuse or dependence? Thats where the Z code is used.
 
Coding for Smokers

I have been researching this issue lately and between what I have read and info I have received from co-workers, I interpret the codes like this;

If a patient uses a tobacco/nicotine product socially/occassionally, it codes to Z72.0 Tobacco Use

If a patient uses a tobacco/nicotine product everyday, they are dependent and therefore the F17 code category is used.

Anybody have additional thoughts on this ?

Thanks.
 
teppynay said:
The term ?Smoker? in the CD-10-CM index, refers the coder to -
see Dependence, drug, nicotine
Click to expand...

Yes, and if you look under the term Tobacco, the second selection is Harmful Use, Z72.0 which further supports my personal thinking that Harmful Use can be the social/occassional smoker.
 
Tobacco Dependence complication vascular condition

I am having difficulty deciding how to code tobacco dependence when the use is not is uncomplicated (how can tobacco dependence be uncomplicated anyway), not in remission nor withdrawal, and the nicotine-induced disorders seem to be "Psychoactive substances, temporarily changing persons mod, perception, behavior and or consciousness".
My patient has AAA and it continues to increase in size and physician has explained that her dependence contributes to this situation along with her high blood pressure. Which codes would you all suggest in this case? Thanks
 
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