Partnership Guide 2023Tobacco and E-Cigarette Use/Abuse

Several diagnostic categories require the use of additional codes for tobacco use. Because of the addictive nature of nicotine and tobacco’s causal relation to pulmonary conditions and cancer, tobacco use history should be documented when clinically relevant and coded appropriately. When the presenting problem for the encounter is for tobacco use the diagnosis should be completely documented with a treatment plan e.g., a cessation program.img1Documentation considerations

Determine current and past consumption

Cigarettes
Chewing tobacco
Pipe
Nicotine gum
E-cigarettes

Passive tobacco exposure

Historical tobacco use (how many packs; how many years)

Past treatment or experience with abstinence

Nicotine dependence has varying levels of severity (mild, moderate and severe)

Signs and symptoms associated with withdrawal or tolerance:

Sweating or racing heart

Hand trembling or seizures

Insomnia

Nausea or vomiting

Hallucinations

Restlessness and anxiety

Medical complications (dyspepsia, lung and oral neoplasms)

Psychiatric complications (depression, anxiety, irritability, psychosis)

Behavioral complications (temper)

Psychiatric comorbidities (depression, anxiety)

Treatment Plan

Prior to any treatment plan, the clinician needs to determine a patient’s willingness to stop tobacco use and implement an accountability strategy, such as a quit date

An effective treatment plan should be multidimensional to achieve success.

Documentation and coding

Documentation of nicotine/tobacco use or dependence is key to provide a proper code assignment in ICD-10 and careful use of terms

ICD-10 codes do not exist for the following:

Tobacco abuse
History of tobacco abuse
History of tobacco use

Drug Abuse and Dependence in the ICD-10-CM provides combination codes for the use of nicotine, including modes of such as cigarettes, chewing tobacco, pipe, and gum

The use of the term “smoking” does not automatically equate with use or dependence without clear provider documentation to the status of tobacco use

Documenting the term “smoker” automatically assumes tobacco dependence per the ICD-10 alphabetic index

Documenting “Packs per day” or “Number of years” does not automatically assume a status of tobacco/nicotine dependence without clear provider documentation to the status

img2Example 1*Diagnosis: Lymphoid interstitial pneumonitis due to vapingCoded as:J84.2 Lymphoid interstitial pneumoniaU07.0 Vaping related disorderExample 2*35 y/o WM presents with mouth lesions. Chewing tobacco use for 20 years, approximately 5 packs per week.Diagnosis: Buccal lesions w/nicotine dependenceCoded as:K13.79 – Unspecified lesions of oral mucosaF17.228 – Nicotine dependence chewing tobacco, with nicotine-induced disorder*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 20232023 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