ICD-10-CM Chapter 5 comes with extensive changes to the subchapters, categories, and subcategories. ICD-9-CM had groupings by psychotic, nonpsychotic disorders, and mental retardation; however, for ICD-10-CM there is a more distinct organization.
Many of these changes were necessary due to the outdated terminology found in ICD-9-CM. For example, ICD-10-CM now contains a separate category for nicotine dependence (F17) with subcategories to identify the specific tobacco product used. This is in comparison to the one ICD-9-CM code, 305.1, for tobacco use disorder or tobacco dependence.
There have also been significant changes to the codes for drug and alcohol abuse and dependence. For example; in reviewing the ICD-10-CM Coding Guidelines Section I.C.5.b.2, there is now a coding 'hierarchy' when the documentation describes use, abuse, and dependence for the same drug.
Let's look at a couple of examples:
- The documentation describes alcohol abuse with intoxication. ICD-10-CM does not specify the severity of alcohol use as previously seen in ICD-9-CM. The code in this instance would be F10.129.
- The documentation describes cocaine dependence. ICD-10-CM code F14.21 should be used. The cocaine dependence is coded as 'in remission' because there are no 'history of' codes for drug dependence in ICD-10-CM.
These changes will most certainly mean that providers will need to be fully educated on the expansion of this chapter’s guidelines so that their documentation fully meets the expectations for accuracy and precise code selection. Coders must perform a careful review of the documentation provided.