Coding, Classification & Reimbursement

Smoker

  • 1.  Smoker

    Posted 06-01-2017 19:04
    I am noticing that "smoker" is being coded differently, depending upon the coder and training.  If the physician does not state "dependence" is it to be coded to  Z72.0, tobacco use?
    Any discussion would be appreciated.

    ------------------------------
    Julia Haynes
    ------------------------------


  • 2.  RE: Smoker

    Posted 06-02-2017 08:52
    Julie,
    In the ICD-10-CM Index, the term "Smoker" refers the coder to see Dependence, drug, nicotine.     Based on this information, the physician does not have to state dependence.    This entry is further supported by Coding Clinic, Fourth Quarter 2013, pg. 108 which states the same.     I have often referred clients to have a discussion with their physicians regarding the use of Z72.0.    One suggestion is that this code may be used in the situation where someone is a social smoker - once in a while.      A daily smoker based on the guidance from the code set and Coding Clinic should be coded in the F17.2 subcategory.

    I have seen Z72.0 used frequently and inappropriately.     Thanks so much for the question!

    ------------------------------
    Laurie Johnson, MS, RHIA, FAHIMA
    Senior Healthcare Consultant
    Panacea Healthcare Solutions
    ------------------------------



  • 3.  RE: Smoker

    Posted 06-02-2017 08:58
    The alphabetic index "Smoker" states: see Dependence, drug, nicotine. This takes you to nicotine F17.200, Nicotine dependence, unspecified, uncomplicated. (if identified substance is known go to that subheading) See CC 4Q 2013 P.108. The coding manual take precedence over all other references. I hope this helps

    ------------------------------
    Dara Bermick, CCS
    Inpatient Auditor and Consultant
    dbermick@gmail.com
    ------------------------------



  • 4.  RE: Smoker

    Posted 06-07-2017 07:51
    When would it be appropriate to use F17.210 vs F17.200?  When the provider says "Current everyday smoker"?

    ------------------------------
    Cheryl Allard
    Specialty Coder
    ------------------------------



  • 5.  RE: Smoker

    Posted 06-02-2017 10:41

    If you look in the Index under the term "smoker", the instruction is to "see Dependence, drug, nicotine".   There is also Coding Clinic 4th quarter 2013 which states the following:

    Question:

    How would a documented diagnosis of "smoker" be coded in ICD-10-CM? Should it be coded as tobacco use or dependence?

    Answer:

    In ICD-10-CM, a diagnosis of "smoker" is coded to dependence. Assign code F17.200, Nicotine dependence, unspecified, uncomplicated, when the provider documents "smoker." Please note the following reference in the Alphabetic Index to Diseases:

    Smoker - see Dependence, drug, nicotine



    ------------------------------
    Greta Ryan, RHIA, CCS, CCS-P
    Coding & Compliance Analyst
    ------------------------------



  • 6.  RE: Smoker

    Posted 06-08-2017 05:39
    Edited by Lawrence Barr 06-08-2017 05:44
    Hello!

    Use F17.200 if the type of tobacco product is not specified.  (cigarettes, cigars, pipe, etc.).  I look for terms like "pack years", or "ppd".  If no specific tobacco product is specified, use F17.200.  And as others have stated, the term "smoker" is considered nicotine dependence.


    ------------------------------
    Lawrence Barr
    President
    ------------------------------



  • 7.  RE: Smoker

    Posted 10-10-2018 11:01

    Hoping to get advice on a "former smoker" diagnosis. If "smoker" goes to dependence, would "former smoker" go to dependence, in remission?



    ------------------------------
    Theresa Guerra, RHIT
    HIM Coder
    ------------------------------



  • 8.  RE: Smoker

    Posted 10-10-2018 13:23
    Theresa,

    We use the remission code if 1 year or less and use the history code Z87.891 if more than 1 year.
    Hope this helps you.





  • 9.  RE: Smoker

    Posted 10-11-2018 09:51
    ​Hello!

    The Official Guidelines state, "Selection of codes for "in remission" for categories F10-F19, Mental and behavioral disorders due to psychoactive substance use (categories F10-F19 with -.11, -.21) requires the provider's clinical judgment. The appropriate codes for "in remission" are assigned only on the basis of provider documentation (as defined in the Official Guidelines for Coding and Reporting), unless otherwise instructed by the classification."

    The term "in remission" is an essential modifier and must be documented if used for code assignment.  If the word "remission" is not documented use the
    history of code.  Please see Coding Clinic 2ND 2017 for a complete discussion on this topic.  "The codes for nicotine dependence in remission should only be assigned when "in remission" is specifically documented by the provider."  This article also states that patients on nicotine replacement with e-cigarettes are considered nicotine dependent to another tobacco product.  Patients still smoking cigarettes and e-cigarettes are assigned two codes.


    ------------------------------
    Lawrence Barr
    President
    ------------------------------