BC Advantage - 2014 Issue 3

ICD-10 and Substance Use

By Heather Greene, MBA, RHIA, CPC, CPMAICD-10-CM has given us a structurally sound and evidence-based system in order to report substance use disorders. With a little bit of perusing and research, a coder will find the reporting of these conditions to be logical, consistent and easily documented. In order to report substance use appropriately in ICD-10-CM, the documentation requirements have changed. The language requirements differ slightly from DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). DSM-5 has combined this condition under Substance Use Disorder, which is then delineated as mild, moderate or severe. This approach is in...

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