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HCC 54 and HCC 55 – Substance Abuse

This month we’re taking a look at substance abuse, its definition, criteria, and the differences between use and dependence.

This is the code range for the conditions related to substance abuse:

ICD-10 Code Description
F10.1-F10.19 Alcohol abuse
F11.1-F11.19 Opioid abuse
F12.1-F12.19 Cannabis abuse
F13.1-F13.19 Sedative, hypnotic or anxiolytic abuse
F14.1-F14.19 Cocaine abuse
F15.1-F15.19 Other stimulant abuse
F16.1-F16.19 Hallucinogen abuse
F18.1-F18.19 Inhalant abuse
F19.1-F19.19 Other psychoactive substance abuse

Psychoactive substance abuse is the use of any substance for nontherapeutic purposes or the use of medication for purposes other than what it’s prescribed for, such as:

  • Use of illicit drugs, like cocaine
  • Misuse of prescribed drugs that stimulate or depress the central nervous system, like amphetamines or barbiturates
  • Habitual use of substances that are commercially available with desired effects, like alcohol

The Differences Between Use and Dependence

Substance Use Dependence

When a psychoactive substance is used to treat a behavioral or mental health disorder.

For documentation purposes, psychoactive substance use must be linked to a mental health or behavioral disorder by a provider.

ICD-10 coding guidelines identify 3 criteria for a definite diagnosis of dependence:

  1. A strong desire or sense of compulsion to take the substance
  2. Difficulties in controlling substance taking behavior
  3. Physical withdrawal symptoms when substance has ceased or has been reduced

ICD-10 coding guidelines also define a hierarchy of reportable psychoactive substance use, abuse, and dependence code designations. When multiple terms (use, abuse, and dependence) are found in provider documentation, only one ICD-10 code should be reported:

  • If use and abuse are documented, report only the code for abuse.
  • If use and dependence are documented, report only the code for dependence.
  • If abuse and dependence are documented, report only the code for dependence.
  • If use, abuse, and dependence are all documented, report only the code for dependence.

 

ICD-10-CM Expert for Physicians
McGraw-Hill concise dictionary of modern medicine ©2002