Tobacco Use & Abuse

Page 19 – ICD-10

When the provider documentation refers to use, abuse and dependence of the same substance, 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.

ICD-10 CM DIAGNOSIS CODE DESCRIPTION

F17.200 Nicotine dependence, unspecified, uncomplicated

F17.201 Nicotine dependence, unspecified, in remission

F17.210 Nicotine dependence, cigarettes, uncomplicated

F17.211 Nicotine dependence, cigarettes, in remission

F17.220 Nicotine dependence, chewing tobacco, uncomplicated

F17.221 Nicotine dependence, chewing tobacco, in remission

F17.290 Nicotine dependence, other tobacco product, uncomplicated

F17.291 Nicotine dependence, other tobacco product, in remission

Tobacco use NOS – Z72.0

History of Tobacco dependence – Z87.891

Tobacco use during pregnancy, childbirth and the puerperium – O99.33

Current Cigarette use – F17.210

Unspecified current cigarette use – F17.200

A person who smokes one pack of cigarettes per day is not an "occasional" smoker.

Per the CDC Glossary on smoking, "Current smoker: An adult who has smoked 100 cigarettes in his or her lifetime and who currently smokes cigarettes. Beginning in 1991 this group was divided into "everyday" smokers or "somedays" smokers."

A person who currently smokes 1ppd is an "everyday" smoker. That person smokes 100 cigarettes every 5 days and by definition is a "smoker".

As previously referenced Coding Clinic, 1st 2004 clearly states providers do need to use exact terminology for code assignment.

From the question, "The physician has documented the patient to have chronic obstructive pulmonary disease (COPD) and acute bronchitis. We would like clarification on whether the documentation has to specifically read "acute exacerbation of COPD" before we can assign code J44.1, Obstructive chronic bronchitis, with (acute) exacerbation."

From the answer, " If the documentation describes the clinical picture as acute bronchitis with COPD, assign code J44.1, Obstructive chronic bronchitis with (acute) exacerbation, followed by code J20.9, Acute bronchitis as a secondary diagnosis, even though the documentation may not specifically state "acute exacerbation of COPD."

While the response is specific to COPD exacerbations, there are other examples. For instance, a documented "exacerbation" of any condition may be considered "acute on chronic" if there is an Index entry of acute and chronic for the condition. The provider does not have to use the exact words "acute on chronic".

Follow the alphabetic index in the ICD-10-CM code book for appropriate code assignment using the main term “Tobacco”

• Tobacco, use code to Z72.0

• Dependence, tobacco directs the coder to – see Dependence, drug, nicotine

• Dependence, drug, nicotine codes to F17.200

• Subcategories under F17 identify specific tobacco products (chewing tobacco, cigarettes, specified product) and specific nicotine-induced disorder (uncomplicated, in remission, with withdrawal, with other nicotine-induced disorders, with unspecified nicotine-induced disorders). Of the F17 (Nicotine dependence) codes, only those specifying dependence “with withdrawal” are CCs, non are MCCs

• The term “smoker” in the ICD-10-CM alphabetic index, refers the coder to — see Dependence, drug, nicotine

• Code assignment for a patient who has a past history of tobacco dependence, not current dependence on tobacco, codes to Z87.891 (personal history of nicotine dependence)

• Electronic cigarettes are battery-powered vaporized devices that turn liquid nicotine into a vapor that can be inhaled

NOTE: Use the documentation provided in the medical record as well as the alphabetic index in the ICD-10-CM codebook to guide you to the appropriate code choice.

Helpful advice comes from the following Coding Clinics:

• Smoker (Tobacco Use versus Dependence) Coding Clinic, Fourth Quarter 2013 Page: 108

• Nicotine Dependence (Uncomplicated, in Remission and With Withdrawal) Coding Clinic, Fourth Quarter 2013 Page: 108

• Nicotine Dependence and Nicotine Induced Disorders Coding Clinic, Fourth Quarter 2013 Page: 109

For Example: The AHA Coding Clinic, 4th Quarter 2013, page 109, discusses the fact that the provider must document a cause and effect relationship between smoking and other disease processes before the coder may link the disease process to smoking.

•

• Example based on this coding clinic: Patient is a current cigarette smoker with a 20 year history of smoking who now presents with emphysema. The physician does not link the smoking to the emphysema in the medical record; therefore, it would not be appropriate for the coder to use F17.218, Nicotine dependence, cigarettes, with other nicotine-induced disorders.

QUIZ

Fred, a chain smoker, has plaque induced chronic gingivitis

A. K05.10, Z87.891

B. K05.10, Z77.22

C. K05.10, Z72.0

D. K05.10, F17.208

Correct Answer

C. K05.10, Z72.0

Explanation

Although Fred is a Chain smoker, there is no documentation to support that he is nothing more than a tobacco user.

The patient is a former smoker:

A. Z72.0

B. F17.200

C. F17.210

D. Z87.891

Comments

Revenue Cycle Management - RCM

When you enter the field of US Healthcare, the first thing you notice right away is the unique terminology that keeps bombarding you! New medical terms and medical slang keep popping up. Added to it is the abbreviations, acronyms and what not.... You feel overwhelmed at first... But gradually with some patience you can master the terms which are used often in your office. I am listing below some common healthcare terms used in Insurance and Billing in RCM. Check them out and hope you will learn a word or two! BILLING TERMS When both you and your health insurance company pay for your health care expenses, it’s called cost sharing. Deductibles, coinsurance and copays are all examples of cost sharing. Understanding how they work will help you know how much you’ll pay. Deductible A deductible is the amount you pay for health care services before your health insurance begins to pay. How it works: If your plan’s deductible is $1,500, you’ll pay 100 percen

What is Medical Coding?

Medical coding is the transformation of healthcare diagnosis, procedures, medical services and equipment into universal medical alphanumeric codes.” Put simply, this refers to the process of translating important medical information into simple codes for the purpose of documenting medical records and informing accurate medical billing. There are a few different types of medical codes used in healthcare settings today, but each of them allows for uniform documentation between medical facilities. Having this standard system allows for a more seamless transfer of medical records and more efficient research and analysis to track health trends. The three main types of codes are ICD-10-CM, CPT-4, and HCPCS What is a medical coder? Medical coders are the individuals responsible for translating physicians’ reports into useful medical codes. These professionals work behind the scenes in a variety of settings, ensuring all pertinent information is coded appropriately to e

CPT Quiz - 40000 Series

Quiz created by Vijayarani Sivakumar with GoConqr

Allograft vs Autograft vs Xenograft

Allo – Same species Auto – Same person Xeno – Animal (different species) An autologous transplant uses a person's own stem cells. ... In a reduced-intensity allogeneic transplant, doctors suppress the recipient's immune system enough so the donor stem cells can take root, or “engraft,” there. An autograft is a bone or tissue that is taken from a part of a person’s own body and transplanted into another. Often, surgeons will use a person’s own hamstring tendon to repair a damaged anterior cruciate ligament. Similarly, an autograft bone may be transplanted from a person’s hip to aide in a spinal fusion. Patients who undergo autograft procedures may experience increased postoperative pain from the second surgical (autograft) site. They may also require longer periods of rehabilitation. The use of allograft is advantageous because there is no second procedure required to remove and transfer a portion of the patient’s native bone or tissue. Surgical time may be

Anatomy & Physiology Quiz

Quiz created by Vijayarani Sivakumar with GoConqr

Necessity of English Proficiency in Medical Coding

Irish Blessing A moonbeam to charm you, A sheltering angel, so nothing can harm you. A sunbeam to warm you, Naturally, being fluent in English places you at an advantage in the field of Medical Coding. That being said, it does not fully eliminate you from entering Coding. Medical Coding is different from Medical Transcription and does not require the same expertise and fluency in English. Medical Transcription careers demand that you be highly fluent in American English, as we get most of our clients from the USA. You need to be tuned to their culture and lifestyle to name a few. But that is not the case with coding. Of course you should have a working knowledge of English. Or else you will be unable to comprehend a Medical Chart. As you need to peruse a medical chart, understand what is being done for a patient and derive the codes. The requirement for fluency in English is not as high as in Transcription. I keep comparing the two fields of transcription and coding becaus

Spleen - Anatomy

The spleen is an organ located in the upper left abdomen, and is roughly the size of a clenched fist. In the adult, the spleen functions mainly as a blood filter, removing old red blood cells. It also plays a role in both cell-mediated and humoral immune responses. The spleen in located in the upper left quadrant of the abdomen, under cover of the diaphragm and the ribcage – and therefore cannot normally be palpated on clinical examination (except when enlarged). It is an intraperitoneal organ, entirely surrounded by peritoneum (except at the splenic hilum). The spleen is connected to the stomach and kidney by parts of the greater omentum – a double fold of peritoneum that originates from the stomach: The spleen has a slightly oval shape. It is covered by a weak capsule that protects the organ whilst allowing it to expand in size. The outer surface of the spleen can be anatomically divided into two: · Diaphragmatic surface – in contact with diaphr

Place Holder X

The letter " x ” serves as a placeholder when a code contains fewer than six characters and a seventh character applies. The " x ” also allows for future expansion of the codes. When reporting ICD - 10 - CM codes, coders must add a placeholder so the seventh character is in the correct position. Not every ICD-10-CM code with a seventh character has a sixth character—or even a fifth or fourth character for that matter. This frequently occurs with poisonings and injuries. The letter "x” serves as a placeholder when a code contains fewer than six characters and a seventh character applies. The "x” also allows for future expansion of the codes. When reporting ICD-10-CM codes, coders must add a placeholder so the seventh character is in the correct position. Without this placeholder to ensure characters appear in the correct positions, codes are invalid. For example, a patient presents with an accidental poisoning by an antiallergic drug. For the initial

US Healthcare - Payment Posting

Payment posting and denial management are two extremely critical steps of the revenue cycle management of any solo practitioner or a healthcare organization. Streamlining these processes improves the RCM cycle leading to lesser delays in the A/R’s, ultimately guiding the way to increasing revenues along with patient satisfaction. Payment posting and its factors: In this process, the payment records of patients are recorded in the billing management software. It also includes attention to be given to claim denials — for identifying the problematic areas and their reasons along with apt actions to be taken on resolving the issues. Insurance Payment Posting: All payers either send an EOB (explanation of benefits) or ERA (electronic remittance advice) towards the payment of a claim. The medical billing staff posts these payments immediately into the respective patient accounts, against that particular claim to reconcile them. The payment posting is handled according to clie

Medical Coding, an excellent career choice!

As we are reeling under the pressure of COVID-19 infection in India, unemployment has reached sky high. Many have tried binge eating, binge cooking and binge watching movies to ward off boredom. So what is an alternative and viable option for our youngsters? Why not try something useful, that will enhance your career, or give a boost to your existing career. Learn something online. Be it a new skill, a new language, or something trending like Medical Coding. Medical Coding is a boon in such testing times. You can learn Medical Coding and re-skill yourself and reshape your career. If you are a graduate looking for an interesting and engrossing profession, Medical Coding checks all the boxes. The basic criteria needed is a college degree. Being tech savvy, which most of the youngsters are already thanks to smart phones, will help you move into this profession quite smoothly. A working knowledge of English is a must, as we receive all the work from USA. Once y

Medical Coding Simplified

Search This Blog