November 26, 2007

Coding for Drug-induced Mental Disorders
For The Record
Vol. 19 No. 24 P. 25

Drug dependence occurs when there is a physical addiction to a drug and the person continues to use the drug despite the negative social, psychological, and physical problems it causes. Patients with drug dependence may develop physical or psychological symptoms related to the drug use. Some common mental disorders related to drug use include the following:

• Drug withdrawal (292.0);

• Drug-induced paranoia (292.11);

• Drug-induced hallucinations (292.12);

• Drug-induced delirium (292.81);

• Drug-induced persisting dementia (292.82);

• Drug-induced persisting amnestic disorder (292.83);

• Drug-induced mood disorder (eg, depression; 282.84);

• Drug-induced sleep disorder (eg, insomnia; 292.85);

• Drug-induced anxiety disorder (292.89); and

• Drug-induced sexual dysfunction (292.89).

Drug Withdrawal
Drug withdrawal (292.0), also documented as withdrawal or abstinence syndrome, occurs when a patient experiences the signs and symptoms associated with discontinuing a drug that he or she has become physically or psychologically dependent on. The signs and symptoms that the patient may experience depend on what drug the patient was taking. Common signs and symptoms of withdrawal include abdominal pain, headaches, nausea and vomiting, diarrhea, drenching sweats, shaking (tremors), seizures, and death.

Principal Diagnosis Selection
When a patient is admitted with a drug-related mental disorder (category 292), it should be sequenced as the principal diagnosis with the code for the drug dependence (category 304) sequenced as a secondary diagnosis. Even if the patient experiences withdrawal after admission, the withdrawal code is sequenced as the principal diagnosis (AHA Coding Clinic for ICD-9-CM, 1994, third quarter, pages 13-14).

If no drug-related mental condition is present, the drug dependence should be sequenced as the principal diagnosis if the patient is admitted for detoxification, rehabilitation, or both. If a patient is admitted for a condition unrelated to the drug dependence, follow the principal diagnosis selection guidelines. If a patient is admitted with a physical condition related to drug dependence, the physical condition should be sequenced as the principal diagnosis. If a patient is pregnant and is admitted with a drug-related problem, the pregnancy code will be sequenced as the principal diagnosis unless the physician specifically states the pregnancy is incidental.

Complication/Comorbidity
With the implementation of the Medicare severity diagnosis-related groups effective October 1, the complication and comorbidity (CC) list was significantly revised. The Centers for Medicare & Medicaid Services also created a major CC (MCC) list. Prior to October 1, 2007, there were 3,326 codes on the CC list. Now, there is a total of 4,927 codes that are either a MCC or CC.

With the updated CC and MCC list, certain drug dependence and drug-induced conditions previously classified as a CC may no longer be considered a CC. The following table identifies if the condition is a MCC, CC, or non-CC.

Coding and sequencing for drug-induced mental disorders are dependent on 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, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to nearly 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.