Template:ICD10 Guideline Chronic Substance Abuse

This template puts the rules for chronic substance abuse into the relevant diagnoses.

To use:

{{ICD10 Guideline Chronic Substance Abuse}}

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Coding substance related ICD10 diagnoses

See ICD10 Guideline for drugs and substances for more info on coding substance related ICD10 diagnoses.

Chronic Substance Abuse Guidelines

• This category indicates, as stated, that the patient has, for the indicated substance, chronic abuse and/or dependency/addiction
• Chronic abuse/dependence/addiction does not necessarily mean there is current acute intoxication or withdrawal
• This is almost always going to be a Comorbid Diagnosis --- and it is a comorbid even if it is being treated in the hospital. For example continuing to get methadone for chronic heroin abuse in hospital is no different than continuing to get an antihypertensive in hospital for hypertension; in both cases the chronic condition is correctly coded as a comorbid.
  • It is very rare (but not impossible) for a patient to become dependent or addicted as an Acquired Diagnoses -- most of these occur in long-stay patients who are getting narcotics for pain and become habituated or addicted, e.g. postoperatively.
  • This is different from when a patient with chronic abuse/addiction isn't recognized to have that until after admission -- THIS is not a acquired diagnosis and should be correctly listed as a Comorbid Diagnosis
• When a patient with a chronic abuse/addiction is admitted and that chronic abuse/addiction is part of the reason for hospital admission (e.g. for inpatient care of addiction), then that diagnosis should be listed as both a Comorbid Diagnosis and also an Admit Diagnosis

• The issue of "chronic abuse/dependence/addiction" is hard to pin down and comes down to a judgment call (specifically, the judgment of collectors and the physicians writing chart notes):
• Obviously it is present if CURRENT dependence or addiction is present.
• But it can exist even in the absence of identified dependence or addiction, if chronic abuse is present.
• There are actually TWO judgments required to identify chronic abuse: (a) what is heavy use, and (b) what duration qualifies as chronic use
  • Furthermore, and complicating the issue, is that chronic abuse is about BOTH duration and quantity.
  • Heavier use for shorter periods COULD be considered as chronic abuse.
  • e.g. even without dependence or addiction, >5 years of heavy or regular use qualifies as "chronic abuse"
  • But the actual CUTOFF for the duration that qualifies as "chronic" is not easily delineated and depends somewhat on how heavy the use is
    • So again, the bottom line for defining "chronic abuse" is a judgment call

Do not code for past drug use

Do NOT include the chronic abuse/dependence/addiction code if the person is no longer using, but DO code any resulting long-term problem, e.g. liver cirrhosis as a result of past alcohol abuse, or ischemic heart disease as a result past cocaine abuse.