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For other articles and previous issues click here. February 28, 2005 Coding
for Substance Dependence and Abuse Substance abuse is the regular or frequent use of an illegal or harmful substance that causes problems in some aspect of a person’s life. Substance dependence includes a group of behavioral and physiological symptoms that indicate the continual, compulsive use of a substance despite the problems related to the use of this substance. Increased amounts are needed to achieve the desired effect or level of intoxication, so the patient’s tolerance for the substance increases. In addition, substance-dependent patients often experience physical signs of withdrawal when there is a sudden cessation of use. ICD-9-CM classifies these conditions as mental disorders and includes the following categories: • 303, Alcohol dependence syndrome • 304, Drug dependence • 305, Nondependent abuse of drugs Alcohol Dependence Chronic alcoholism may lead to serious medical conditions. The following are common complications of alcoholism. The code assignment should be based on physician documentation and should be coded as “alcoholic” only if the physician documents it as an alcoholic complication or due to alcohol. • Alcoholic hepatitis (571.1) • Cirrhosis (571.2) • Gastritis (535.3x) • Pancreatitis (577.0) • Cardiomyopathy (425.5) The patient who is dependent on alcohol is also at an increased risk for cancer, heart failure, stroke, and hypoglycemia. Alcohol Abuse Drug Dependence • 304.0, Opioid type dependence • 304.1, Sedative, hypotic, or anxiolytic dependence • 304.2, Cocaine dependence • 304.3, Cannabis dependence • 304.4, Amphetamine and other psychostimulant • 304.5, Hallucinogen dependence • 304.6, Other specified drug dependence, including glue sniffing and inhalant dependence • 304.9, Unspecified drug dependence Code 304.7 is assigned when the patient is dependent to a combination of drugs and one of them is an opioid type drug. Assign code 304.8 when an opioid type is not involved in the combination of drugs used. Drug Abuse Fifth-Digit Subclassification The appropriate fifth-digit code assignment is based on documentation in the medical record. “It is common for technical and professional personnel other than the attending physician to provide much of the documentation in facilities dealing with detoxification and rehabilitation, and it is appropriate to accept this documentation for the purpose of assigning fifth digits” (AHA Coding Clinic for ICD-9-CM, 1991, second quarter, page 11). If the documentation is not available in the medical record, the physician should be queried for clarification. Principal Diagnosis Selection Treatment • Methadone • Clonidine • Long-acting barbiturates or benzodiazepines • Carbamazepine Detoxification may last for four or five days. Rehabilitation requires a written structured program with the goal of replacing drug/alcohol dependence with activities that are nonchemical in nature (AHA Coding Clinic for ICD-9-CM, 1991, second quarter, pages 12-13). Coding and sequencing for substance dependence and abuse are dependent upon the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding. — This information was prepared by Audrey Howard, RHIA, and Vicki Sippel, RHIA, of 3M Health Information Systems (800-367-2447), a leading supplier of coding and classification systems to nearly 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payors as the result of the misuse of this coding information. |
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