Increased E-Cigarette Use Creates Conundrum for Coders

e-cigarettes medical coding guidelines

Here’s a question for you: what’s the appropriate ICD-10-CM code diagnosis for a patient who uses electronic cigarettes? According to the National Institutes of Health’s National Institute on Drug Abuse, electronic cigarettes, also called e-cigarettes or electronic delivery systems, supply a vaporized dose of nicotine infused with flavorings and other chemicals. Users inhale these substances in a vapor instead of in smoke. The liquids vaporized in the e-cigarettes typically consist of a mixture of propylene glycol, glycerin, nicotine, and flavorings.

What ICD-10-CM Code Would You Choose?

Perhaps surprisingly, ICD-10-CM carries no medical coding guidelines or classifications for e-cigarette use. Back in the olden days of ICD-9-CM, you probably would have reached for 305.1 (Nondependent tobacco use disorder). The GEM crosswalk for 305.1 is F17.200 (Nicotine dependence, unspecified, uncomplicated). However, you probably guessed that ICD-10 gives you many more options for nicotine use, including the following:

  • F17.200, Nicotine dependence, unspecified, uncomplicated
  • F17.201, Nicotine dependence, unspecified, in remission
  • F17.210, Nicotine dependence, cigarettes, uncomplicated
  • F17.211, Nicotine dependence, cigarettes, in remission
  • F17.220, Nicotine dependence, chewing tobacco, uncomplicated
  • F17.221, Nicotine dependence, chewing tobacco, in remission
  • F17.290, Nicotine dependence, other tobacco product, uncomplicated
  • F17.291, Nicotine dependence, other tobacco product, in remission

FDA Seeks Power to Regulate Electronic Cigarettes

Currently, the FDA can only regulate e-cigarettes marketed for therapeutic purposes, such as when used as smoking cessation aide devices. The FDA also regulates nicotine replacement therapies like nicotine gum, patches, lozenges, inhalers, and nasal sprays, as well as medications such as bupropion (Zyban) and varenicline (Chantix). The FDA also regulates, through its Center for Tobacco Products (CTP), cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobaccos such as chewing tobacco and snuff.

However, the FDA recently issued a proposed rule that would extend its tobacco authority to cover products that meet the legal definition of a tobacco product, such as e-cigarettes. You can find more information about this proposed rule at the FDA site here.

No Regulation Means No Safety Checks for E-Cigarettes

According to the American Lung Association, the public and individual health risks of e-cigarettes are still mostly unknown. Moreover, without regulation, the Lung Association adds that there exist no safety checks or requirements for what can go into an e-cigarette.

E-cigarettes, including e-pens, e-pipes, e-hookahs, and e-cigars, are collectively called electronic nicotine delivery systems, or ENDS. These devices are usually battery powered, using a heating element to warm e-liquid from a refillable cartridge that releases a chemical-filled aerosol solution.

Learn What’s In E-Cigarettes

Though some argue that nicotine-free e-cigarettes are common, the American Lung Association disputes that assertion, saying that almost all e-cigarettes contain nicotine. It adds that because of the lack of regulation and oversight, even some products claiming to be nicotine-free may still contain that drug, citing a 2009 FDA study that showed cartridges labeled as nicotine free actually showed traceable levels of nicotine present.

Other substances found in e-cigarettes can include toxic, cancer-causing chemicals like formaldehyde, as well as a chemical found in antifreeze. Flavors are also of concern, not only because candy-like flavors may induce children to begin e-cigarette use, but also because some flavoring agents may be unsafe to inhale.

Have You Run Into E-Cigarette Coding Yet?

How did you handle it? Let us know in the comment box below. We love to hear from you!

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About 

Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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