ETOH withdrawal
I was reviewing this coding clinic:
Coding Clinic, Second Quarter ICD-10 2015 Page: 15 Effective with discharges: July 6, 2015
Question:
The Index entry for Alcohol, withdrawal, leads to code F10.239, Alcohol dependence with withdrawal. However, only alcohol abuse is documented by the physician. In ICD-10-CM, how is alcohol abuse with alcohol withdrawal coded?
Answer:
In ICD-10-CM, alcohol withdrawal is categorized as alcohol dependence, by default. The classification provides a combination code for alcohol dependence with alcohol withdrawal. Therefore query the provider for clarification, when alcohol abuse and alcohol withdrawal are both documented in the health record.
Are you guys routinely querying for this? And if so, do you have a sample query?
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Coding Clinic, Second Quarter ICD-10 2015 Page: 15 Effective with discharges: July 6, 2015
Question:
The Index entry for Alcohol, withdrawal, leads to code F10.239, Alcohol dependence with withdrawal. However, only alcohol abuse is documented by the physician. In ICD-10-CM, how is alcohol abuse with alcohol withdrawal coded?
Answer:
In ICD-10-CM, alcohol withdrawal is categorized as alcohol dependence, by default. The classification provides a combination code for alcohol dependence with alcohol withdrawal. Therefore query the provider for clarification, when alcohol abuse and alcohol withdrawal are both documented in the health record.
Are you guys routinely querying for this? And if so, do you have a sample query?
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Comments
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Or... am I mis-interpreting the coding clinic entirely? Set me straight!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, February 10, 2016 8:29 AM
To: Kathryn Good
Subject: [cdi_talk] ETOH withdrawal
I was reviewing this coding clinic:
Coding Clinic, Second Quarter ICD-10 2015 Page: 15 Effective with discharges: July 6, 2015
Question:
The Index entry for Alcohol, withdrawal, leads to code F10.239, Alcohol dependence with withdrawal. However, only alcohol abuse is documented by the physician. In ICD-10-CM, how is alcohol abuse with alcohol withdrawal coded?
Answer:
In ICD-10-CM, alcohol withdrawal is categorized as alcohol dependence, by default. The classification provides a combination code for alcohol dependence with alcohol withdrawal. Therefore query the provider for clarification, when alcohol abuse and alcohol withdrawal are both documented in the health record.
Are you guys routinely querying for this? And if so, do you have a sample query?
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
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It is my understanding that Alcohol dependence is physical or psychological dependence on alcohol. Though there other indicators of dependence, alcohol withdrawal is a pretty significant finding as it shows physical dependence on alcohol. I believe in the DSM IV you need more than one criteria to officially dx dependence. Things like tolerance or continues use despite harm, things like that. I have occasionally seen people with alcohol withdrawal occur in people we would not typically have thought of as dependent. We occasionally see this with older patients with scheduled surgeries why ‘report’ they drink 1-2 drinks a day prior to surgery, are functional, and alcohol doesn’t seem to have otherwise impacted their life much. But generally, we see withdrawal in our alcoholic, homeless, population. Yes, people often abuse alcohol and are not dependent. But those people do not generally withdraw.
I would love to hear other opinions on this as well. Our coders will not currently code withdrawal without documentation of dependence.
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, March 11, 2016 9:16 PM
To: Kathryn Good
Subject: Re: [cdi_talk] ETOH withdrawal
" If their withdrawing they are dependent" is not correct. Dependent to me means addicted or alcoholic. Someone can be abusing and not be addicted or dependent. Dependent is a serious labeling of a patient. I would think that a provider would be very cautious in using that term on a patient.
Christina Rivera, RN,BSN,CCDS
Sent from my iPhone
On Mar 11, 2016, at 6:13 PM, CDI Talk wrote:
Alrighty, no one responded to this last time but I am trying again;-). I am building a query template for this. To me, the root of the issue is that we need ‘dependence’ documented. Do you agree? If so, I am thinking about just querying for that. Which seems silly because if they are withdrawing they are dependent. Thoughts???
Or… am I mis-interpreting the coding clinic entirely? Set me straight!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, February 10, 2016 8:29 AM
To: Kathryn Good
Subject: [cdi_talk] ETOH withdrawal
I was reviewing this coding clinic:
Coding Clinic, Second Quarter ICD-10 2015 Page: 15 Effective with discharges: July 6, 2015
Question:
The Index entry for Alcohol, withdrawal, leads to code F10.239, Alcohol dependence with withdrawal. However, only alcohol abuse is documented by the physician. In ICD-10-CM, how is alcohol abuse with alcohol withdrawal coded?
Answer:
In ICD-10-CM, alcohol withdrawal is categorized as alcohol dependence, by default. The classification provides a combination code for alcohol dependence with alcohol withdrawal. Therefore query the provider for clarification, when alcohol abuse and alcohol withdrawal are both documented in the health record.
Are you guys routinely querying for this? And if so, do you have a sample query?
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
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I'm new to this forum so I am interested to learn.
Holly Simpson MD
Case Management Medical Advisor | Community Health Network
1500 North Ritter Ave. | Indianapolis, IN 46219
317.355.4038 | ecommunity.com
This is what I have come up with. I believe the Coding clinic I mentioned was mis-interpreted to mean that when MD’s are documenting ‘withdrawal’ that they also need to document ‘dependency’ in order for them to code the CC; F10.239 Alcohol dependence with withdrawal, unspecified. However, with close reading of the CC what it appears to be saying is that by ‘default’ withdrawal = dependency. If the provider only states alcohol withdrawal then F10.239 should be coded. However, if the provider documents alcohol use or alcohol abuse and alcohol withdrawal, this is a problem and a query is needed.
This is because in coding substance abuse/use there is a hierarchy regarding Use/Abuse/dependency. So the issue is that if withdrawal = dependency and then the provider also says ‘abuse’, this is a discrepancy. ‘abuse’ vs ‘dependence’. So a query is needed to clear up the discrepancy.
I hope that makes sense. I discussed it further with our coding manager and we are in agreement.
I am (still) open to other interpretations
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, March 15, 2016 11:42 AM
To: Kathryn Good
Subject: RE:[cdi_talk] ETOH withdrawal
one of the requirements for diagnosis of alcohol withdrawal according to the DSM V is "cessation of (or reduction in) alcohol use that has been heavy and prolonged". That is alcohol dependence. Episodic alcohol use or abuse is not likely to cause withdrawal. I'm not a coder, but why is the explicit documentation of dependence required to diagnose withdrawal? I am sure our coders do not require that. You can't code withdrawal any other way can you?
I'm new to this forum so I am interested to learn.
Holly Simpson MD
Case Management Medical Advisor | Community Health Network
1500 North Ritter Ave. | Indianapolis, IN 46219
317.355.4038 | ecommunity.com
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Vanessa Falkoff RN
Clinical Documentation Improvement Coordinator
University Medical Center of Southern Nevada
1800 W Charleston Blvd
Las Vegas, NV
vanessa.falkoff@umcsn.com
office 702-383-7322
Compassion * Accountability * Respect * Integrity
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, March 15, 2016 12:41 PM
To: Vanessa Falkoff
Subject: RE: RE:[cdi_talk] ETOH withdrawal
Hi Holly,
This is what I have come up with. I believe the Coding clinic I mentioned was mis-interpreted to mean that when MD’s are documenting ‘withdrawal’ that they also need to document ‘dependency’ in order for them to code the CC; F10.239 Alcohol dependence with withdrawal, unspecified. However, with close reading of the CC what it appears to be saying is that by ‘default’ withdrawal = dependency. If the provider only states alcohol withdrawal then F10.239 should be coded. However, if the provider documents alcohol use or alcohol abuse and alcohol withdrawal, this is a problem and a query is needed.
This is because in coding substance abuse/use there is a hierarchy regarding Use/Abuse/dependency. So the issue is that if withdrawal = dependency and then the provider also says ‘abuse’, this is a discrepancy. ‘abuse’ vs ‘dependence’. So a query is needed to clear up the discrepancy.
I hope that makes sense. I discussed it further with our coding manager and we are in agreement.
I am (still) open to other interpretations
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator Flagstaff Medical Center Kathryn.Good@nahealth.com
Cell: 928.814.9404
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, March 15, 2016 11:42 AM
To: Kathryn Good
Subject: RE:[cdi_talk] ETOH withdrawal
one of the requirements for diagnosis of alcohol withdrawal according to the DSM V is "cessation of (or reduction in) alcohol use that has been heavy and prolonged". That is alcohol dependence. Episodic alcohol use or abuse is not likely to cause withdrawal. I'm not a coder, but why is the explicit documentation of dependence required to diagnose withdrawal? I am sure our coders do not require that. You can't code withdrawal any other way can you?
I'm new to this forum so I am interested to learn.
Holly Simpson MD
Case Management Medical Advisor | Community Health Network
1500 North Ritter Ave. | Indianapolis, IN 46219
317.355.4038 | ecommunity.com
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CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: kathryn.good@nahealth.com If you would like to be removed from CDI Talk, please send a blank email to leave-cdi_talk-12649561.a6bbaf3538c19e934e5136fbd051a6b1@hcprotalk.com
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923 This message has been scanned and no issues were detected.
Do not trust links or attachments and do not divulge sensitive information upon email request.
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CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
Holly Simpson MD
Case Management Medical Advisor | Community Health Network
1500 North Ritter Ave. |Indianapolis, IN 46219
Ph. 317.355.4038 |eCommunity.com