Pulmonology Coding Alert

Prepare to use F17.200 for nicotine dependence beginning Oct. 1, 2013.

Thinking of habitual smokers as nicotine dependent can help guide your ICD-10 code selection. Under ICD-9, dependence on tobacco, to the detriment of a patient's health or social functioning, would be reported with code 305.1 (Nondependent abuse of drugs; tobacco use disorder).

ICD-10 difference: When ICD-9 transitions to ICD-10 on Oct. 1, 2013, you will modify your tobacco use disorder coding from 305.1 to the appropriate code from series F17.2 (Nicotine dependence, unspecified, uncomplicated). When using your ICD-10 manual, note that the following entries will contain back-references to F17.200:

• Dependence (on) (syndrome) F19.20

drug NEC F19.20

nicotine F17.200

• Tabacism, tabacosis, tabagism -- see also Poisoning, tobacco

Meaning dependence (without remission) F17.200

Coder tips: Before selecting F17.200, ensure that a more specific code is not warranted. Specificity is a key factor for ICD-10. F17.200 merely indicates that the patient is tobacco dependent; the doctor likely documented a definitive smoking habit (i.e., "patient smokes X packs cigarettes per day"). The 5th digit in this code series denotes the tobacco product (0= unspecified; 1 = cigarettes; 2 = chewing tobacco; and 9 = other tobacco products). The 6th digit indicates the status of the dependence (0= uncomplicated; 1= in remission; 3=with withdrawal; 8= with other nicotine-induced disorders; 9= with unspecified nicotine-induced disorders).

Additionally, the smoking cessation counseling code may also qualify for Z71.6 (Encounter for tobacco abuse counseling). This code would be listed first, along with the appropriate code from the F17.2 series (i.e. Z71.6, F17.218 [nicotine dependence, cigarettes, with other nicotine-induced disorders], J44.9 [COPD, unspecified]).