Psychoactive Substance Use Reporting

Drug and alcohol use continues to rise in the United States. In 2020, there was an estimated 25.9 million Americans using alcohol and 10.9 million using drugs (either illegal drugs or overuse of prescription drugs). The numbers rose even more during the COVID-19 pandemic. In 2021, over 106,000 drug overdose deaths were reported with the majority (70,601) being opioid related. Opioids are the #1 drug used by Americans illegally w/o a prescription. There were also more than 88,000 deaths related to alcohol use.

With alcohol and drug use on the rise, there are updated guidelines to follow for reporting in ICD-10-CM.

When to Report?

Drug and alcohol use should only be reported when there is a physical, mental, or behavioral disorders associated with the use and documented by the provider. Keep in mind we are talking about drug and alcohol USE, not abuse or dependence. There was some confusion in coding when the addition of “physical” was added to the description. AHA Coding Clinic for ICD-10-CM/PCS, First Quarter 2020: Page 9 did clarify that this would be a condition such as sexual dysfunction or sleep disorder. These do appear in Chapter 5 but are not considered mental disorders.

The Official Coding Guideline (OCG) (I.C.5.b.3) states “These codes for unspecified psychoactive substance use (F10.9-, F11.9-, F12.9-, F13.9-, F14.9-, F15.9-, F16.9-, F18.9, F19.9-) are to be used only when the psychoactive substance us is associated with a physical, mental or behavioral disorder, and such relationship is documented by the provider.”

The relationship between the drug/alcohol use and the condition must be documented by the provider. An example would be a patient with alcohol use and a diagnosis of anxiety. Would the coder report this as alcohol induced anxiety since the patient has both documented? No. The conditions must be documented to be related to code. The fact that the patient has both, does not equate to the patient having alcohol induced anxiety disorder. There are many causes of anxiety, and it may be that the patient has another cause unrelated to the alcohol use. See AHA Coding Clinic for ICD-10-CM/PCS, First Quarter 2022: Page 33 and 34.

Also, another example is when the coder sees in the social history or HPI documented “Alcohol Use: Yes.” or “Patient uses alcohol. This is not a diagnosis to be coded. This documentation is not meeting OCG I.C.5.b.3.

As stated, the above information is for codesF10.9-, F11.9-, F12.9-, F13.9, F14.9-, F15.9-, F16.9-, F18.9- and F19.9-.

Chapter Specific Exception:

There is an exception to the above. When the patient presents and is pregnant with drug or alcohol use there does not need to be any further documentation or relationship by the provider. The Chapter 15 OCG would take priority. In these cases, “it is the provider’s responsibility to state that the condition being treated is not affecting the pregnancy.” So, a pregnant patient with cocaine use during pregnancy would be coded with the Chapter 15 code O99.32- as well as F14.90 unless the provider states that this is NOT affecting the pregnancy.

Stats and Interesting Information Regarding Drug Use:

• In 2016 West Virginia had the highest rate of opioid overdose deaths.
• City of Baltimore had the highest rate of opioid overdose deaths in 2017.
• One survey shows that the top 5 states for drug use are (all drugs):
  • #1—New Mexico
  • #2—West Virginia
  • #3—District of Columbia
  • #4—Louisiana
  • #5—Colorado
• The same survey shows that the 5 states with the lowest drug use are (all drugs):
  • #47—Idaho
  • #48—Minnesota
  • #49 Florida
  • #50 Utah
  • #51 Hawaii
• Montana has the most drunk drivers involved in fatal crashes.
• 61% of people in Montana use alcohol.
• Vermont has the highest use of marijuana.
• Oregon has the second highest use of marijuana.
• Colorado has the highest rate of cocaine use.
• 64% of people in Colorado use alcohol.
• Delaware has the highest heroin use.

Coders should review the entire patient record to ensure that the relationship between alcohol/drug use and physical, mental, or behavioral disorders are documented appropriately. Best practice is to code it right from the start.

Authored by Kim Boy, RHIT, CDIP, CCS, CCS-P

References
https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates
https://www.state.gov/addressing-the-overdose-crisis
https://www.guardianrecoverynetwork.com/detox-and-recovery-for-alcohol-addiction/the-top-10-most-abused-drugs-in-the-u-s/
https://time.com/james-nachtwey-opioid-addiction-america
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7516293
https://wallethub.com/edu/drug-use-by-state/35150
https://www.wccbcharlotte.com/2023/05/15/states-with-the-highest-drug-use-in-america/
https://www.samhsa.gov/newsroom/press-announcements/202110260320
Coding Clinic, First Quarter 2022 Pages: 33 & 34
Coding Clinic, Fourth Quarter 2020 Page: 16
Coding Clinic, First Quarter 2020 Page: 9
Coding Clinic, Fourth Quarter 2018 Page: 57
ICD-10-CM Official Guidelines for Coding and Reporting FY 2023 Pages: 41 & 42

Since 1992, HIA has been the leading provider of compliance audits, coding support services and clinical documentation audit services for hospitals, ambulatory surgery centers, physician groups and other healthcare entities. HIA offers PRN support as well as total outsource support.

The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.