Look to .11 When Documentation Shows Substance Abuse ‘In Remission’

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Substance abuse disorder coding got more detailed options and clarifying notes in the 2018 version of ICD-10-CM. The good news is that now that we’re a few months in, you may have noticed that these changes helped bring your code choices more in line with current clinical practice. Here’s a refresher on how your code choices changed.

Make Sure You’ve Got .11 Options on Cheat Sheets

The added specificity for substance abuse coding means better data collection from ICD-10-CM codes and more accurate information in the patient’s record, too. Specifically, ICD-10-CM 2018 added codes ending in .11 for substance abuse in remission. You’ll want to be sure you have these available in your ICD-10-CM resources (cheat sheets, too!) if you code for these diagnoses. Here are the codes:

  • F10.11 (Alcohol abuse, in remission)
  • F11.11 (Opioid abuse, in remission)
  • F12.11 (Cannabis abuse, in remission)
  • F13.11 (Sedative, hypnotic or anxiolytic abuse, in remission)
  • F14.11 (Cocaine abuse, in remission)
  • F15.11 (Other stimulant abuse, in remission)
  • F16.11 (Hallucinogen abuse, in remission)
  • F18.11 (Inhalant abuse, in remission)
  • F19.11 (Other psychoactive substance abuse, in remission).

The categories that got the .11 addition are F10-F16 and F18-F19. What about F17 (Nicotine dependence)? This explanation may help. All the other categories have these fourth-character subcategories:

  • .1, abuse
  • .2, dependence
  • .9, unspecified.

Category F17 has only one fourth-character subcategory: F17.2 (Nicotine dependence). It expands out after that into about 20 sixth-character reportable codes, but they all are classified to dependence, not abuse.

Know the Notes to Code Mild, Moderate, Severe Correctly

Notes included under the new .11 codes clarify that they apply in cases when the record shows a mild disorder is in early or sustained remission.

That brings us to the next big addition to F10-F19 in 2018. The code set added notes under .21 in F10-F16 and F18-F19 explaining that the codes apply to moderate or severe substance use disorder in early or sustained remission.

Tip: These notes match with an instruction added in the ICD-10-CM Official Guidelines for 2018 (Section I.C.5.b.1) that, “Mild substance use disorders in early or sustained remission are classified to the appropriate codes for substance abuse in remission, and moderate or severe substance use disorders in early or sustained remission are classified to the appropriate codes for substance dependence in remission.”

One more helpful hint: These notes weren’t the only ones added. To make it easier to see the additions, look at the Tabular ICD-10-CM FY 2018 Addenda PDF (available on the CDC’s ICD-10-CM site) to see what changed in the current code set. A benefit of using the addenda is that you can see additions, deletions, and revisions without having to sift through what stayed the same.

What About You?

Have you found that these substance abuse coding changes helped make it easier to code in line with what your provider includes in the documentation?

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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