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Experience. Integrity. Advocacy.

Examining ICD-10-CM Codes for Mental, Behavioral and Neurodevelopmental Disorders – Part 2

As illustrated and explained in the first article of the series, ICD-10-CM Chapter 5 contains more subchapters, categories, subcategories, and codes than ICD-9-CM. In addition, ICD-10-CM also contains updated terminology and more nuanced classifications of substance abuse.

A great example of how ICD-10-CM now represents updated terminology and replaces the outdated terminology of ICD-9-CM, is category F17. Category F17 is a separate category for nicotine dependence with subcategories to identify the specific tobacco product and nicotine-induced disorders. ICD-9-CM has one single code (305.1) for tobacco use disorder or tobacco dependence.

Category F17 is a huge improvement in how we are able to code disease processes and their relationship to tobacco use or dependence. We know that from COPD to Lung Cancer to Heart Disease, our providers are seeing the ramifications that patients progressively suffer when using tobacco products, and we now can code for those conditions with specificity.

This then makes it possible for us track tobacco us in relation to other diseases and illnesses, so that we might better understand the magnitude of what it is costing our healthcare system financially and our patients physically. Naturally, this will allow our providers to put in place more appropriate treatment plans and know what preventive measures can be used to educate and counsel this population of patients.

Consistent with the knowledge providers have today, there is a substantial classification change made to the codes for drug and alcohol abuse and dependence. The identification of the stage of the substance use, namely continuous or episodic, is not utilized in ICD-10-CM.

A single ICD-10-CM code now identifies not only the substance but also the disorder the substance use induced. In line with ICD-9-CM, ICD-10-CM will continue to use codes for substance dependence “in remission.” ICD-10-CM classification system does not provide separate “history” codes for alcohol abuse and drug abuse. These are classified as “in remission.”

There are now unique codes for substance use (not specified as abuse or dependence), and abuse and dependence, so careful review of the documentation is required to accurately code for the patient’s situation. Further, we now have combinations codes for drug and alcohol use and associated conditions, such as withdrawal, sleep disorders, or psychosis. In addition, we also have a code specific to the blood alcohol level (Y90-) to be assigned as an additional code when documentation indicates its use.

The substance use, abuse, and/or dependence codes cover a range of disorders that differ in severity from uncomplicated intoxication and use, to psychotic disorders and dementia, but all are due to the use of psychoactive substances.

Additionally, there are codes that include increased specificity to identify the pathophysiology of the disorder including aspects of use (the withdrawal state), the effects (abuse and dependence), and common manifestations (alcohol abuse with alcohol-induced delirium). The substance involved is indicated in the second and third characters of the ICD-10-CM code. he fourth and fifth digits then specify the clinical state. Here is an example of what these codes look like:

F11.15 Opioid abuse with opioid-induced psychotic  disorder

F11.150 Opioid abuse with opioid-induced psychotic disorder with delusions

F11.151 Opioid abuse with opioid-induced psychotic disorder with hallucinations

F11.159 Opioid abuse with opioid-induced psychotic disorder, unspecified

Listed at the beginning of the category F11.1 is this Excludes 1 note:

Excludes 1 Opioid dependence (F11.2-)

Opioid use, unspecified (F11.9-)

Continue to follow this series as we dig deep into the ICD-10-CM, Chapter 5 – Mental, Behavioral, and Neurodevelopmental Disorders.

For more ICD-10 articles, please visit our ICD-10 Updates page.

— Compiled by former CIPROMS ICD-10 Coordinator, Angela Hickman, CPC, CEDC, AHIMA-Approved ICD-10 CM/PCS Trainer, AHIMA Ambassador. All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com.

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