ICD10 Guideline for drugs and substances: Difference between revisions

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{{ICD10 coding guideline}}
{{ICD10 coding guideline}}
== Additional Info ==
*When used for a '''[[Primary Admit Diagnosis]]'''
**'''Code the physiologic/lab/etc manifestation that is most responsible for admission''' (e.g. if the overdose or poisoning caused renal failure AND shock, code the shock as [[Primary Admit Diagnosis]] as it's most immediately life threatening), '''NOT the agent or agents themselves as [[Primary Admit Diagnosis]]'''
**'''Code ALL the physiologic/lab/etc manifestations of the overdose or poisoning''' (e.g. renal failure, respiratory failure, shock, etc).
**If the admission is just to '''observe the patient only''' (i.e. perhaps the patient MAY have taken a dangerous drug or substance and does not YET have a physiologic manifestation requiring admission) then '''code [[Primary Admit Diagnosis]] as [[Observation for SUSPECTED overdose]]'''
*Regarding overdoses or poisonings with multiple agents
**Code all the agents known to have been taken
**In the case where some are known but others are suspected then also use [[Drug or biological substance/agent NOS, overdose/toxicity]], and/or [[Substances NOS, poisoning]] for those others suspected
**When there is a multi-agent overdose and none of the agents are clearly known, then just code [[Drug or biological substance/agent NOS, overdose/toxicity]] and/or [[Substances NOS, poisoning]]
* also see [[Illicit drug use]]


== Categories of ICD10 Codes ==
{{Discuss |Task
*This is a bit confusing because there are TWO DIMENSIONS to these ICD10 codes
* just realized that [[Illicit drug use]] wasn't mentioned here; we might want better info how it fits into the remaining instructions on this page.  
**The first dimension is the type of agent/substance
**The second dimension is the category of medical problem related to the agent/substance
 
*Regarding the type of agent/substance we're talking about
*The categories included are: 
**Psychoactive drugs/substances/agents (F10-F19) -- this category are substances of abuse, not pharmaceuticals.  Includes: alcohol, opioids, sedative/hypnotics, cocaine, stimulants (including methamphetamine), hallucinogens (including hallucinogenic mushrooms), solvents + a a "wastebasket" of "Psychoactive substance NOS"
**Drugs/biologics -- these are pharmaceutical agents
 
 
*Regarding the category of medical problem, the options are:
**'''"intoxication, acute"'''
**Chronic abuse/dependence/addiction
**Withdrawal
**Poisoning/overdose
**Poisoning/toxic effects
**Adverse effect of drugs used properly
 
'''[[Drug or biological substance/agent NOS, overdose/poisoning]]'''
***Non-medicinals
 
*For psychoactive drugs/substances/agents :
**These include: 
***And finally there is
*For each agent
 
**{{#ask: [[Has ICD10Dx::~"*intoxication, acute"]]
|limit=0
|format=broadtable
|link=all
|class=sortable wikitable smwtable
|searchlabel= Drug/substance '''intoxication, acute'''...
}}
}}
{{Discuss | who = Allan | question = | Do we need to rename [[Psychoactive substance NOS, acute intoxication]] and [[Alcohol (ethanol) acute intoxication (drunkenness)]] to include in here?  Ttenbergen 11:40, 2018 June 19 (CDT)}}


**{{#ask: [[Has ICD10Dx::~*"overdose/poisoning"]]  
== Coding in ICD10 of Issues Related to Drugs and Substances ==
|limit=0
There are 6 categories of ICD10 codes related to drugs/biologics/agents/substances -- they are DISTINCT and it’s important to distinguish between them.
|format=broadtable
*[[:Category:Overdose]]
|link=all
*[[:Category:Adverse effect]]
|class=sortable wikitable smwtable
*[[:Category:Poisoning by non-pharmaceuticals]]
|searchlabel= Drug/substance '''overdose/poisoning'''...
*[[:Category:Acute intoxication]]
}}
*[[:Category:Addiction]]
*[[:Category:Withdrawal]]


**{{#ask: [[Has ICD10Dx::~*"chronic abuse/dependence/addiction"]]
*While many of the specific drugs or agents or substances have codes that fall under multiple of the categories (e.g. opioids), there is not perfect symmetry, i.e. there may be an individual code for a given agent in one category, while for another category that agent may instead go into a wastebasket code.  Benzodiazepines are one such example.
|limit=0
|format=broadtable
|link=all
|class=sortable wikitable smwtable
|searchlabel= Drug/substance '''chronic abuse/dependence/addiction'''...
}}
{{Discuss | who = Allan | question =  |Do we need to rename [[Tobacco use/abuse, chronic]] so it includes in here? Ttenbergen 11:59, 2018 June 19 (CDT) }}
 
**{{#ask: [[Has ICD10Dx::~*"withdrawal"]]
|limit=0
|format=broadtable
|link=all
|class=sortable wikitable smwtable
|searchlabel= Drug/substance '''withdrawal'''...
}}
 
**{{#ask: [[Has ICD10Dx::~*"used appropriately, adverse effect (reaction, allergy, hypersensitivity)"]]
|limit=0
|format=broadtable
  |link=all
|class=sortable wikitable smwtable
|searchlabel= Drug/substance '''used appropriately, adverse effect (reaction, allergy, hypersensitivity)'''...
}}


*Regarding confusion between '''intoxication, acute''' vs. '''overdose/poisoning'''
== Intravenous Drug Abuse (IVDA) ==
**Acute intoxication indicates just that. Being drunk is a good example of acute alcohol intoxication.  These generally require just observation, not treatment.
*There is no specific code in ICD10 for intravenous drug use/abuse (ivda). The codes that DO exist are for the specific agent or type of agent being used/abused --- irrespective of how it enters the body.
**On the other hand, an overdose/poisoning indicates that the patient either has a medical consequence, or is at high risk of getting one -- so that some medical treatment is given.  These treatments might include: substance removal via activated charcoal, gastric lavage or dialysis; use of an antidote or neutralizing agent; life support if the overdose caused shock or respiratory failure; or others.
**But clearly there can be some overlap.  A common example is the drunk person who is felt in the ED to be "not protecting their airway" and so is intubated for this rationale.  Because it is so difficult to judge the "need" for such things, the rule we will use to distinguish between them is to use '''intoxication, acute''' if no treatment is given, and to use '''overdose/poisoning''' if treatment is given.
*Regarding confusion between '''withdrawal''' vs. '''chronic abuse/dependence/addiction'''
**Withdrawal refers to the presence of withdrawal symptoms or signs.
**Chronic abuse/dependence/addiction does not necessarily indicate that anything acute is currently occurring.
**These 2 codes can be used together, if appropriate.
*Regarding confusion between '''used appropriately, adverse effect (reaction, allergy, hypersensitivity)''' vs. '''overdose/poisoning'''
**The difference here is that '''used appropriately''' refers to use of a pharmaceutical used in the correct dose.  While if that drug is given or taken in excess amount, an '''overdose/poisoning''' can occur.
*Regarding confusion between '''used appropriately, adverse effect (reaction, allergy, hypersensitivity)''' vs. '''intoxication, acute'''
**These 2 codes can be used together, if a pharmaceutical is used in the correct dose, and that leads nonetheless to acute intoxication.


== Other instructions related to drugs and substances in IC10 ==
Several templates area applied to the relevant pages:


See [[:Category:Drug and substance template]]


{{Discuss | who = Allan | question =  
{{#ask: [[Category:Drug and substance template]]
*AG NOTES TO SELF:
|format = UL
**Include here explanations distinguishing between the various types of codes: intoxication, acute; chronic abuse, dependence, addiction; withdrawal, AE used appropriately; overdose/poisoning.
|limit = 1000
**Specially give guidelines for distinguishing acute intox vs. OD/poisoning; and acute vs. chronic
|default = None found
}}
}}


{{Discuss | who = Allan | question = This is an evil twin of [[Overdose vs used appropriately/adverse effect]]. This seems to be the healthier twin, though, so maybe it's the one we should keep, evil or otherwise. We'd need to reconcile the two and make sure the links are fixed. Allan, if you can make sure all the content of [[Overdose vs used appropriately/adverse effect|the twin]] is present in here and let me know then I will fix the links at the same time as linking all the other diagnoses to this page via [[Template:ICD10 Guideline drugs and substances]].Ttenbergen 12:32, 2018 June 19 (CDT)}}
[[Category:ICD10 Coding Guidelines]]
 
[[Category:Addiction]]
[[Category: ICD10 Coding Guidelines]]

Latest revision as of 16:47, 8 September 2025

This page contains an ICD10 Coding Guideline for ICD10 collection. See ICD10 coding guidelines for similar pages.

Additional Info

Task

  • just realized that Illicit drug use wasn't mentioned here; we might want better info how it fits into the remaining instructions on this page.
  • SMW


  • Cargo


  • Categories

Coding in ICD10 of Issues Related to Drugs and Substances

There are 6 categories of ICD10 codes related to drugs/biologics/agents/substances -- they are DISTINCT and it’s important to distinguish between them.

  • While many of the specific drugs or agents or substances have codes that fall under multiple of the categories (e.g. opioids), there is not perfect symmetry, i.e. there may be an individual code for a given agent in one category, while for another category that agent may instead go into a wastebasket code. Benzodiazepines are one such example.

Intravenous Drug Abuse (IVDA)

  • There is no specific code in ICD10 for intravenous drug use/abuse (ivda). The codes that DO exist are for the specific agent or type of agent being used/abused --- irrespective of how it enters the body.

Other instructions related to drugs and substances in IC10

Several templates area applied to the relevant pages:

See Category:Drug and substance template

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