Resolved Alcohol use/abuse/unspecified

[KatieW_70689]

Ok so from what I've gathered...if the provider didn't document it, it can't be coded...we can't assume anything etc etc etc...so with that in mind..

"acute alcohol intoxication" is documented

the correct code was F10.129 Alcohol abuse with intoxication, unspecified

I had landed on F10.929 Alcohol use, unspecified with intoxication, unspecified

After reading through guidelines i.C.5.b.3 I see that I can't use F10.929 because this wasn't associated with a substance related disorder..etc etc

The guidelines point me to what is documented....but the provider didn't specify Use/Abuse/Dependence etc....

I thought F10.929 (don't laugh at me lol) because the only one that was making sense to me was the fact that she had used alcohol...everything else seemed to point to she has a problem with it but that wasn't stated

So how do you know which code is correct?
Am I missing something simple here? It's something simple isn't it...lol

 

[Lori]

When you index intoxication it leads you to alcohol intoxication acute without dependence F10.129

Unspecified Defined​

According to a presentation by the National Association of Rural Health Clinics (NARHC), unspecified is defined as:

Coding that does not fully define important parameters of the patient condition that could otherwise be defined given information available to the observer (clinician) and the coder.

When to Use Unspecified Codes​

• The patient may be early in the course of evaluation, meaning the clinician may not yet know enough to apply a more specific code
• The claim may be from a provider who is not directly related to the diagnosis of the patient’s condition
• The clinician seeing the patient may be more of a generalist who is not able to define the condition at a level of detail expected by a specialist

When Not to Use Unspecified Code​

• There is sufficient information available to more accurately define the condition
• They can account for basic concepts such as:
  • Laterality (right, left, bilateral, unilateral)
  • Anatomical locations
  • Trimester (of pregnancy)
  • Type of diabetes
  • Known complications or comorbidities
  • Description of severity, acuity, or other known parameters
• They implement care that demands a more specific level of detail
• They’re specialists, because as specialists, they should be able to provide the detail required

Can You Ever Use an Unspecified ICD-10 Code? | WebPT

A discussion of when physical therapists can use unspecified ICD-10 codes. Click here to learn more about your ability to use an unspecified ICD-10 code.

www.webpt.com

Please see this free resource thread on use abuse & dependence to learn more on this topic:

Resource - Coding Use Abuse & Dependence

ICD-10-CM Official Guidelines for Coding and Reporting FY 2022 5. Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01 – F99) a. Pain disorders related to psychological factors Assign code F45.41, for pain that is exclusively related to psychological disorders. As indicated by...

www.cco.community