ICD-10 solves some old problems, but also creates new ones

As each day passes, we get closer to the implementation date of ICD-10-CM and ICD-10-PCS. I have been scouring the ICD-10 manual to identify things that will change (some things for the better, some not so much). For example, substance abuse/dependence codes (ICD-9-CM categories 303-305) in ICD-10 present solutions to ongoing challenges for coders but also create new issues.

In ICD-9-CM, we are given specific descriptors for the fifth digit (e.g., continuous, episodic) for substance abuse or dependence depending on the frequency of substance abuse. Do physicians usually document these specific terms? Not really. We seem to default to the fifth digit ‘0’ for ‘Unspecified’ more often than not. So what’s new and great when it comes to assigning codes for substance abuse and dependence in ICD-10-CM?

In ICD-10-CM, the only ICD-9-CM fifth digit descriptor that has a counterpart in ICD-10 is ‘in remission’. This solves one problem but leaves us with the age old issue of “once an alcoholic, always an alcoholic.” So when is it considered ‘in remission’ and when is it a history of alcoholism?

You will still need to assign codes based on physician documentation because there is a separate code for a personal history of alcohol dependence (F10.21). ICD-10-CM will get very specific in relation to alcohol abuse (F10.1xx) and alcohol dependence (F10.2xx). The 6th digits further identify the following:

• Uncomplicated
• Intoxicated
• Associated with an alcohol induced disorder
• Other specific information

Many times physicians do not document specifics such as “abuse” or “dependence.” So one note of interest is that in ICD-10-CM, coders have a new code category that indicates just alcohol use (F10.9). It excludes those conditions described as abuse or dependence.

At first, I started to think that this may cause patients to refrain (even more than they probably do now) when they provide information related to drinking habits, especially when a code can be assigned for it. But the good news is that this code is only meant to be reported for patients with current intoxication and/or alcohol induced disorders, not just simply alcohol use. The categories for drug abuse, dependence and use are set up exactly like the codes for alcohol disorders with categories for abuse, dependence and use.

ICD-10-CM will also provide additional specificity with supplementary codes for blood alcohol levels (Y90).

Y90: Evidence of alcohol involvement determined by blood alcohol level

Code first any associated alcohol related disorders (F10)

• Y90.0 Blood alcohol level of less than 20 mg/100 ml
• Y90.1 Blood alcohol level of 20-39 mg/100 ml
• Y90.2 Blood alcohol level of 40-59 mg/100 ml
• Y90.3 Blood alcohol level of 60-79 mg/100 ml
• Y90.4 Blood alcohol level of 80-99 mg/100 ml
• Y90.5 Blood alcohol level of 100-119 mg/100 ml
• Y90.6 Blood alcohol level of 120-199 mg/100 ml
• Y90.7 Blood alcohol level of 200-239 mg/100 ml
• Y90.8 Blood alcohol level of 240 mg/100 ml or more
• Y90.9 Presence of alcohol in blood, level not specified

I think this could be helpful with criminal investigations for drunk driving accidents, work accidents, and other alcohol-related disorders that can be further identified by the amount of alcohol content in the patient’s blood.

ICD-10-CM adds specificity, but it still does not solve all of the problems we encounter with ICD-9-CM, such as knowing when to assign a history of alcoholism and when to code as alcoholism “in remission.” Makes our jobs all the more interesting, right? I’ll post some other topics like this in future blog posts. Happy coding!