Tobacco use/abuse, chronic

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Revision as of 09:27, 2020 September 23 by Ttenbergen (talk | contribs) (broke unrelated question into its own, linked to the redirect for marijuana that this question made me realize we need.)
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ICD10 Diagnosis
Dx: Tobacco use/abuse, chronic
ICD10 code: F17.1
Pre-ICD10 counterpart: none assigned
Charlson/ALERT Scale: none
APACHE Como Component: none
APACHE Acute Component: none
Start Date:
Stop Date:
External ICD10 Documentation

This diagnosis is a part of ICD10 collection.

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    • 2019-01-01
    • 2999-12-31
    • F17.1
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Additional Info

  • I think the consensus among data collectors is that we code this when they have a history of using tobacco even if they've not smoked for 5,10, etc years due to the consequences that often occur. Should we have a past history, tobacco use/alcohol use code? From what I understand, we shouldn't code any resolved comorbs unless they are a "past history" code. - Brynn

includes smoking cigarettes, cigars and chewing tobacco.

    • Thanks for bringing that up. So it sounds like people are not following the general chronic substance abuse guideline, which I think means we should bring this to the task meeting so we can all get on the same page. I updated the question to put it on the list, and it would be good if a collector adopted it to present it at task.
      • it appears some are using different cut off time.Trish Ostryzniuk 16:07, 2020 August 28 (CDT)
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  • Do we/should we code medical marijuana here?--Mailah Damian 09:01, 2020 September 18 (CDT)
    • see also for other dxs that might capture this Ttenbergen 09:27, 2020 September 23 (CDT)
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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.

Alternate ICD10s to consider coding instead or in addition

Candidate Combined ICD10 codes

Related CCI Codes

Data Integrity Checks (automatic list)

none found

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