Partnership Guide 2023Substance Use/Abuse/Dependence

For an on-demand webinar, click here or navigate to MedicareProviders.Cigna.com > Provider Education > Disease-Specific Training.img1Severity of SUD – DSM-5 severity is based on the number of diagnostic criteria met by the patient at the time of diagnosis:Determination of severity should be based on an assessment of the presenting symptoms and the DSM-5 criteria for establishing a diagnosis of substance use disorder. The DSM-5 and ICD- 10-CM classify the levels of severity differently; DSM-5 uses mild, moderate and severe, and ICD- 10-CM utilizes use, abuse, and dependence ICD-10-CM has two categories, abuse and dependence.

Documentation of use, abuse, and/or dependence of the same substance should be assigned only one code based on a hierarchy of severity

Abuse is reported when documented with use Use is reported when documented alone, without mention of abuse or dependence

Prevalence and statistics

According to the 2019 National Survey on Drug Use and Health (NSDUH), 14.5 million people age 12 and older had Alcohol Use Disorder (AUD)

6.3% engaged in heavy alcohol use in the past month

85,000 deaths a year in the United States attributed to alcohol use and abuse

Prescription drug use in the United States prevalence is 3.4% of people age 26 and older in the past year

21%–29% misuse prescribed opioid drugs for chronic pain

Illicit drug use

83.8% of overdose deaths involved illicitly manufactured fentanyls, heroin, cocaine, or methamphetamine (alone or in combination)

Substance use/abuse/dependence – screeningThe TAPS Tool has two components. The first component (TAPS-1) is a four-item screen for tobacco, alcohol, illicit drugs, and non-medical use of prescription drugs. If an individual screens positive on TAPS-1, the tool will automatically begin the second component (TAPS-2), which consists of brief substance-specific assessment questions (TAPS-2) to arrive at a risk level for that substance. Clinicians are encouraged to provide positive feedback to patients who screen negative and support their choice to abstain from substances.Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) Tool (drugabuse.gov)

Treatment plans should detail the all steps taken to manage the substance disorder, Including, but not limited to the following:.

Medications
Counseling and behavioral therapy
Referrals to psychiatry or psychology
Twelve-step programs offering mutual aid, such as Alcoholics Anonymous, Narcotics Anonymous, etc.
Close monitoring of patient’s behavior, i.e., regular follow-ups

Document findings to support the diagnosis of Substance Use/Abuse/Dependence and the current manifestations when applicable. Secondary diagnoses, such as depression or anxiety, should be coded additionally

Medical complications including liver disease (i.e., cirrhosis) or neurological diseases (e.g., dementia) require additional codes to describe comorbid conditions

img2resourceTipTo help ensure you are documenting to the highest degree of specificity for appropriate ICD-10 code assignment, go to MedicareProviders.Cigna.com > Provider Education.img3img4Example 1*Assessment: Patient has experienced multiple episodes of severe cocaine use disorder, with dependence spanning approximately eight years. Patient has been in complete for remission the last five years.Coded as: F14.21 Cocaine dependence in remissionExample 2*Patient admitted to unit with anxiety, irritability and paranoia. Previous admissions for cocaine substance disorder.Assessment: Cocaine withdrawalCoded as: F14.93 Cocaine use, unspecified, with withdrawal*The sole purpose of the examples is to demonstrate the application of coding guidelines discussed in the materials. Examples do not represent complete documentation of a condition, nor provide any clinical advice. Each patient and medical record is unique, and assignment of codes depends solely on the distinct documentation within an individual record.Providers must confirm the accuracy of their diagnoses to ensure that diagnosis and coding practices comply with ICD-10-CM Official Guidelines for Coding and Reporting and all applicable legal requirements. Failure to address diagnosis inaccuracies can result in administrative sanctions and potential financial penalties. Accurate coding and submission activities allow us to provide the best benefits and resources possible to our customers.This guide is informational and not meant to replace the clinician’s judgment when caring for the patient.Content updated April 2023TipTo help ensure you are documenting to the highest degree of specificity for appropriate ICD-10 code assignment, go to MedicareProviders.Cigna.com > Provider Education.2023 Medicare Advantage Partnership GuideWelcomeContentsDocumentation Best Practices2023 Medicare Advantage ICD-10-CM Quick Reference Code GuideDisease-Specific Webinar LinksConditioning Reporting GuideReporting Common ConditionsAtrial FibrillationCancerChronic Kidney Disease (CKD)Chronic Obstructive Pulmonary Disease (COPD)Congestive Heart Failure (CHF)DVT and PEDementiaDiabetes Mellitus (DM)Major DepressionObesityPeripheral Artery Disease (PAD)Substance Use/Abuse/DependenceTobacco and E-Cigarette Use/AbuseSocial Determinants of Health