March 18, 2010 | | Comments 2
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Codes for tobacco use and exposure illustrate how ICD-10 captures details

Currently in ICD-9-CM, there are only a few ways to capture present, past, or exposure to tobacco smoke. In ICD-9-CM, we currently have the following codes:

  • 305.1 (Tobacco use disorder)
  • V15.82 (History of tobacco use)
  • 649.0x (Tobacco use disorder complicating pregnancy, childbirth or the puerperium)
  • E869.4 (Accidental poisoning by second-hand tobacco smoke)

However in ICD-10-CM, we will have the opportunity to explore the many different ways that tobacco smoke can affect a patient’s health status. Consider ICD-10-CM code F17.2xxx (Nicotine dependence). The expansion to the seventh digit increases the code specificity by identifying the type of tobacco product (e.g., cigarettes versus chewing tobacco) as well the nature of the dependence (e.g., uncomplicated, in remission, with withdrawal, or other nicotine induced disorders).

Note the following ICD-10-CM codes:

  • Z72.0 (Problems related to lifestyle, tobacco use NOS)
  • Z58.7 (Problems related to physical environment, exposure to environmental tobacco smoke [acute] [chronic])

These codes are classified like an ICD-9-CM V-code as a status influencing health status and will likely be assigned for cases in which the physician does not document nicotine dependence but maybe something like “social smoking” and for the latter just merely second-hand smoke exposure (not resulting in a poisoning).

The following two codes are similar in format to the ICD-9-CM codes for these diagnoses:

  • Z87.82 (Personal history of nicotine dependence)
  • O99.33x (Smoking [tobacco] complicating pregnancy, childbirth and the puerperium)

The expansion of poisoning code T65.2xxx (Toxic effect of tobacco and nicotine) identifies the type of tobacco (cigarettes versus chewing tobacco) as well as the intent of the exposure (accidental, intentional, assault, or undetermined), representing a nice combination of our current poisoning codes and E codes into a single code.

In ICD-9-CM, there currently are no specific codes for the newborn to identify exposure or definitive conditions directly caused by the mother’s use of tobacco during the perinatal period. But consider the following ICD-10-CM codes:

  • P96.81 (Exposure to [parental][(environmental] tobacco smoke in the perinatal period)
  • P04.2 (Newborn [suspected to be] affected by maternal use of tobacco)

In ICD-9-CM, there are essentially four different ways to identify tobacco use or other such related conditions. In ICD-10-CM, that number doubles. ICD-10-CM will give us the opportunity to report with greater specificity for tobacco use and exposure, but it is only one of many coding scenarios. Stay tuned for more examples of this as I continue to explore ICD-10-CM.

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Shannon McCall About the Author: Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, is director of coding and HIM at HCPro, Inc. Shannon serves as the director over the Certified Coder Boot Camp ® programs. She developed the Certified Coder Boot Camp® – Inpatient Version, the Evaluation and Management Boot Camp and most recently the ICD-10 Basics Boot Camp®. As a member of HCPro, Inc.’s Revenue Cycle Institute, Shannon works with hospitals, medical practices and other healthcare providers on a wide range of coding-related issues with a particular focus on education. Shannon has extensive experience with coding for both physician and hospital services. Prior to joining HCPro, she worked for a national medical practice management company, where her duties included serving as a client manager and as an instructor for the in-house coding training. Shannon also previously worked for a national consulting firm focusing on hospital inpatient, outpatient and ER services. Shannon is accredited as a Registered Health Information Administrator and a Certified Coding Specialist and a Certified Coding Specialist – Physician and an ICD-10-CM certified trainer by the American Health Information Management Association. She is also accredited as a Certified Professional Coder and a Certified Evaluation and Management Coder and is considered an approved instructor of the Professional Medical Coding Curriculum by the American Academy of Professional Coders. She is certified as a Certified Clinical Documentation Specialist and also actively serves as an advisory board member of the Association of Clinical Documentation Improvement Specialists (ACDIS). She served as the 2008-2009 Elected Director of the Virginia Health Information Management Association. Shannon holds a Bachelor of Science in Health Information Administration degree from the Medical University of South Carolina.

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  1. Great article. Note that there is another ICD-9-CM tobacco related code, 989.84, Toxic effect of tobacco.

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