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

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