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]]
{{Discuss |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.
}}


== Coding in ICD10 of Issues Related to Drugs and Substances ==
== Coding in ICD10 of Issues Related to Drugs and Substances ==
=== Introduction ===
There are 6 categories of ICD10 codes related to drugs/biologics/agents/substances -- they are DISTINCT and it’s important to distinguish between them.
*This is a bit confusing because there are TWO OVERLAPPING DIMENSIONS to these ICD10 codes
*[[:Category:Overdose]]
**(1) The type of agent/substance
*[[:Category:Adverse effect]]
**(2) The category of problem related to the agent/substance
*[[:Category:Poisoning by non-pharmaceuticals]]
*Not all categories of problems relate to all types of agents/substances
*[[:Category:Acute intoxication]]
*[[:Category:Addiction]]
*[[:Category:Withdrawal]]


=== Regarding the type of agent/substance ===
*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.
*The categories included are: 
**Psychoactive drugs/substances/agents -- these are substances of abuse, not pharmaceuticals. Includes: alcohol, opioids, sedative/hypnotics, cocaine, stimulants (including methamphetamine), hallucinogens (including hallucinogenic mushrooms), solvents + a wastebasket of "NOS"
**Drugs/biologics -- these are specific pharmaceutical agents + wastebaskets of "NOS"
**Non-medicinal substances -- these are toxins/poisons, including toxic alcohols( methanol, ethylene glycol, isopropyl alcohol), organic solvents, acids, metals, carbon monoxide, gases/fumes/vapors, pesticides, food poisoning, cyanide, venom from animals + a wastebasket of "NOS"


=== Categories of medical problem and the agents to which they can be used: ===
== Intravenous Drug Abuse (IVDA)  ==
*{{#ask: [[Has ICD10Dx::~"*intoxication, acute"]]
*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.
|limit=0
 
|format=broadtable
== Other instructions related to drugs and substances in IC10 ==
|link=all
Several templates area applied to the relevant pages:
|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)
*AG REPLY -- Tina, I've been reworking this stuff to make it clearer.  See the above.  I like these lists you've made. But for this list add:  F10.0 and F19.0 }}
*{{#ask: [[Has ICD10Dx::~*"chronic abuse/dependence/addiction"]]
|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)
*AG REPLY -- here we need to add F15.2.  As for the tobacco issue, I'd leave it out from this list, i.e. have it be separate. }}
*{{#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)'''...
}}
**Includes: reaction, allergy, or hypersensitivity to the drug


*The final two categories are: "overdose/poisoning" and "poisoning/toxic effect"
See [[:Category:Drug and substance template]]
*They seem similar, but they don't overlap because they apply to different agents. 
**overdose/poisoning is the term used in application to drugs/biologics
**poisoning/toxic effect is the term used in application to nonmedicinal substances


*{{#ask: [[Has ICD10Dx::~*"overdose/poisoning"]]  
{{#ask: [[Category:Drug and substance template]]
|limit=0
|format = UL
|format=broadtable
|limit = 1000
|link=all
|default =  None found
|class=sortable wikitable smwtable
  |searchlabel= Drug/substance '''overdose/poisoning'''...
}}
}}
{{Discuss | who = Tina |
*AG ISSUE -- Tina I've tried here to clarify the apparent confusion between "intoxication, acute" vs. "overdose/poisoning.  We need 2 separate lists for these, so need to make the 2nd of them which includes the 14 items T51.0 to T65.9 }}
=== To Clarify How Agent Type and Medical Problems Mix & Match ===
*Regarding confusion between '''intoxication, acute''' vs. either '''overdose/poisoning''' or '''poisoning/toxic effect"
**Acute intoxication indicates just that.  Being drunk is a good example of acute ethanol intoxication.  These generally require just observation, not treatment.
**On the other hand, an overdose, poisoning or toxic effect 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: 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''' or '''poisoning/toxic effect" 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.
{{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:ICD10 Coding Guidelines]]
[[Category:Addiction]]

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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