Coding Nicotine Dependence in ICD-10

Q: Nicotine dependence is very common among our patient population. Our primary care office is trying to prepare for ICD-10-CM, and I know that codes for this condition have expanded. Can you explain exactly what our physicians must document?

A: Codes for nicotine dependence have definitely expanded in ICD-10-CM, and it’s great that you are trying to prepare for these changes in advance. In ICD-10-CM, coders must choose from among 20 codes when reporting nicotine dependence. (Note: In ICD-9-CM, code 305.1 is the only code to denote nicotine dependence). Each of these ICD-10-CM codes specifies whether the nicotine is from cigarettes, chewing tobacco, or some other tobacco product. These codes, which also specify whether the dependence is uncomplicated, in remission, or with withdrawal, are all included in ICD-10-CM category F17.

When educating physicians regarding documentation changes, keep the following strategies in mind:

• Ask physicians to clarify whether the nicotine is from cigarettes, chewing tobacco, or some other tobacco product.

• Ask physicians to link the nicotine dependence to any nicotine-induced disorders resulting from that dependence. These disorders could include – but aren’t limited to – end-stage chronic obstructive pulmonary disorder, oral cancer, emphysema, or lung cancer. This is important because ICD-10-CM includes codes that specify the presence of a disorder that’s linked directly to the patient’s nicotine dependence (e.g., F17.218 which denotes nicotine dependence from cigarettes with other nicotine- induced disorder).

• Clarify whether the dependence is uncomplicated, in remission, or with withdrawal. Physicians must perform a thorough history to obtain this information from the patient. Templates within the EHR can help remind physicians to ask for this information. More specific coding for this condition can greatly assist with research related to the effects of nicotine use and abuse.

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