ICD-10 Coding for History of Drug Abuse(F11.21, Z86.59)
Complete ICD-10-CM coding and documentation guide for History of Drug Abuse. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to History of Drug Abuse
F10-F19Primary Range
Mental and behavioral disorders due to psychoactive substance use
This range includes codes for substance use, abuse, dependence, and remission.
Personal history of other mental and behavioral disorders
Used for documenting resolved substance use disorders without current symptoms.
Family history of alcohol and drug abuse
Used for documenting family history impacting patient care.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| F11.21 | Opioid dependence, in remission | Use when opioid dependence is documented as in remission. |
|
| Z86.59 | Personal history of other mental and behavioral disorders | Use when documenting a resolved history of substance use without current symptoms. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for history of drug abuse
Essential facts and insights about History of Drug Abuse
Primary ICD-10-CM Codes for history of drug abuse
Decision Criteria
clinical Criteria
- Patient is in sustained remission from opioid dependence.
documentation Criteria
- Provider notes 'in remission' status.
Applicable To
- Opioid dependence in sustained remission
Clinical Validation Requirements
- Provider documentation stating 'in remission'
- Negative urine drug screen for opioids
Code-Specific Risks
- Incorrectly coding as active dependence without remission documentation
Coding Notes
- Ensure 'in remission' is explicitly documented by the provider.
Z86.59 - Personal history of other mental and behavioral disorders
Use when documenting a resolved history of substance use without current symptoms.
Applicable To
- History of drug abuse
Excludes
- Current drug abuse or dependence
Clinical Validation Requirements
- Provider documentation of resolved substance use disorder
Coding Notes
Ensure the condition is fully resolved before using this code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Family history of alcohol and drug abuse
Z81.1Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting History of Drug Abuse to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F11.21.
Impact
Clinical: May lead to inappropriate treatment plans., Regulatory: Non-compliance with coding guidelines., Financial: Potential for claim denials.
Mitigation Strategy
Educate providers on documentation requirements, Implement EHR prompts for remission status
Impact
Reimbursement: May result in incorrect DRG assignment and reimbursement issues., Compliance: Could lead to audit findings for inaccurate coding., Data Quality: Impacts the accuracy of patient health records.
Mitigation Strategy
Query the provider for clarification on remission status or resolution.
Impact
Lack of explicit remission documentation can lead to audit findings.
Mitigation Strategy
Train providers on the importance of documenting remission status.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for History of Drug Abuse, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for History of Drug Abuse
Use these documentation templates to ensure complete and accurate documentation for History of Drug Abuse. These templates include all required elements for proper coding and billing.
Outpatient follow-up for substance use disorder
Specialty: Primary CareRequired Elements
- Substance name
- Remission status
- Last use date
- Current treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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