By: Lorna Simons, CPC
Medco Consultants, Inc
It is seldom that we go a week without seeing a new opioid linked headline in the news. As medical coders and healthcare professionals it is important to understand the nuances of coding for opioid use (prescribed or recreational), abuse and dependence. Though three separate sections of the ICD-10-CM book can be used to code patients using opioids (Chapter 21 Factors influencing health status and contact with health services (Z00-Z99); Chapter 5 Mental, Behavioral and Neurodevelopmental disorders (F01 – F99) and; Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)), we will be focusing on the difference between prescribed and recreational use abuse and dependence (chapters 21 and 5).
Prescription use of opioids is identified in Chapter 21 of the ICD-10-CM manual. When a patient is receiving prophylactic prescription maintenance for a condition using an opioid it should be documented and coded with Z79.891 Long term (current) use of opiate analgesic. Do not use this code for patients who have addiction or are seeking treatment for addiction. The Chapter 21 Guidelines state: “This subcategory is not for use of medications for detoxification or maintenance programs to prevent withdrawal symptoms in patients with drug dependence (e.g., methadone maintenance for opiate dependence). Assign the appropriate code for the drug dependence instead.”
The codes for opioid related disorders are found in Chapter 5 under category F11. The term “use” in Chapter 5 can mean non-prescription (recreational) use or any use not documented as abuse or dependence. The distinction between use, abuse and dependence is based on clinical evaluation and documentation. As per the ICD-10-CM guidelines for coding substances use, abuse and dependence, “only one code should be assigned to identify the pattern of use based on the following hierarchy:
- If both use and abuse are documented, assign only the code for abuse
- If both abuse and dependence are documented, assign only the code for dependence
- If use, abuse and dependence are all documented, assign only the code for dependence
- If both use and dependence are documented, assign only the code for dependence.”
A patient with a history of opioid abuse or dependence should be coded with the appropriate remission code (F11.11 Opioid abuse, in remission or F11.21 Opioid dependence, in remission). ICD-10-CM does not include a code for history of opioid use.
ICD-10-CM Coding Guidelines Section C.5. Psychoactive Substance Use, Abuse and Dependence
ICD-10-CM Coding Guidelines Section C.21. Factors influencing health status and contact with health services (Z00-Z99)
ICD-10-CM Coding Guidelines Section C.19. Injury, poisoning, and certain other consequences of external causes (S00-T88)