Wiki Help with Coding Substance Abuse ICD-10 CM

[ryaryeet]

Hello All,

I am a coder in training, and I have been having a hard time wrapping my head around the F-codes. I am struggling a lot with F10-F19, specifically when to use F1_.10 (___ abuse/dependence/use, "uncomplicated") vs F1_._88 (___ abuse/dependence/use with other ___-induced disorder). My difficulties revolve around coding physiological disorders with the substance abuse codes when the tabular section says to for example, "Use additional code to identify: alcohol abuse and dependence (F10.-)".

For example, a patient has alcoholic cirrhosis of the liver (without ascites) due to alcohol dependence. My novice coding mind is thinking the liver damage would be K70.30 and the alcohol dependence is F10.288 (alcohol dependence with other alcohol induced disorders). There has been discussion in my class as to whether the correct alcohol dependence code should be F10.20 (alcohol dependence, uncomplicated). I think the confusion stems from the codes other than F10.20 in the F10.2- subcategory, seem to focus on psychological/neurological disorders. Then F10.20 would be appropriate for physiological disorders stemming from alcohol dependence.

If any coders who have had experience with a situation like this could weigh in, I would greatly appreciate the assistance. I am referencing the ICD-10 CM 2020 by AAPC. (pgs 543-544, 734)

p.s. Please do not hesitate (be blunt with me) to give me direction. Thank you.

 

[cpc2007]

Hi! My take on this one based on the ICD-10-CM guidelines and conventions in the tabular is that you would code the K70.30 for the alcoholic cirrhosis without ascites and the F10.20 for alcohol dependence, uncomplicated. Couple of reasons I would go in this direction:

1) As you stated, the conditions in more specified codes under subcategory F10.2- focus more on psychological/neurological complications stemming from alcohol dependence rather than physiologic manifestations.

2) If we back up even a little further to the section header for categories F10-F19, it states "mental and behavioral disorders due to psychoactive substance use (F10-F10)." So again seems the "with other alcohol-induced disorder" in F10.288 would refer to mental/behavioral disorders not physiologic manifestations like cirrhosis.

3) The includes/clarifying terms underneath F10.288 state "alcohol use disorder, moderate, with alcohol-induced mild neurocognitive disorder" and "alcohol use disorder, severe, with alcohol-induced mild neurocognitive disorder" (again focused on mental/neurologic disorders).

4) Finally, if we go to category K70 which is for "alcoholic liver disease" and the category where we find the K70.30, the instructional note for all codes in this category says "use additional code to identify alcohol abuse and dependence (F10.-). All of the conditions under K70 are by definition physiologic manifestations in the liver from abuse or dependence on alcohol. If the intent of the ICD-10-CM guidelines was to say that the code for "with other alcohol-induced disorder" should be used for physiologic manifestations, I think the guidelines here would say to report F10.188 or F10.288 specifically for abuse or dependence with other alcohol-induced disorder specifically rather than leaving it open to report any code from F10.-. This final detail bolsters my thoughts from looking at the codes, section titles, and instructional notes in category F10 that the intent of F10.288 is not to represent alcohol-induced physiologic disorders, and we would back out to F10.20 for alcohol dependence uncomplicated.

I cannot find anything more definitive (a specific guideline in ICD-10-CM, an AHA Coding Clinic, etc.) that covers this scenario. When that happens, I try to look at all the evidence I do have and draw the best logical conclusion I can that doesn't violate any of the rules, and that's where the evidence takes me on this one.

On a side note, kudos to you for asking great questions during your training! A huge part of coding is just being willing to question what you think you know and ask the questions and keep pulling on threads that ultimately lead you in the right direction .

Have a great night
Kim
www.codingmastery.com

 

[ryaryeet]

Hello Kim,

Thank you so much for your detailed response. Upon reviewing the book, I see what you mean about the codes referencing the psychological/neurological manifestations since the category is titled: "Mental and behavioral disorders due to psychoactive substance abuse". So, for reporting substance abuse/dependence/use without mental manifestations, I will default to F1_._0: __ abuse/use/dependence, uncomplicated.

I really appreciate your assistance with helping me finally understand this conundrum that has been bugging me for weeks. You are amazing. I hope you don't mind if I implore you for help in the future.

Best,

Ryan

 

[cpc2007]

Hello Kim,

Thank you so much for your detailed response. Upon reviewing the book, I see what you mean about the codes referencing the psychological/neurological manifestations since the category is titled: "Mental and behavioral disorders due to psychoactive substance abuse". So, for reporting substance abuse/dependence/use without mental manifestations, I will default to F1_._0: __ abuse/use/dependence, uncomplicated.

I really appreciate your assistance with helping me finally understand this conundrum that has been bugging me for weeks. You are amazing. I hope you don't mind if I implore you for help in the future.

Best,

Ryan

You're welcome! Always happy to help - feel free to message me here on AAPC or through my contact page on my website . Website is www.codingmastery.com

Kim