ICD-10 Coding for Polysubstance Abuse(F19.10, F19.20)
Complete ICD-10-CM coding and documentation guide for Polysubstance Abuse. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Polysubstance Abuse
F19.1-F19.9Primary Range
Mental and behavioral disorders due to multiple drug use and use of other psychoactive substances
This range covers disorders related to the use of multiple substances, including abuse, dependence, and related complications.
Poisoning by drugs, medicaments and biological substances
These codes are used for specific substance poisoning and are often used in conjunction with F19 codes to specify the substances involved.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| F19.10 | Polysubstance abuse, uncomplicated | Use when the patient uses multiple substances without meeting criteria for dependence. |
|
| F19.20 | Polysubstance dependence | Use when the patient meets criteria for dependence on multiple substances. |
|
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 polysubstance abuse
Essential facts and insights about Polysubstance Abuse
Primary ICD-10-CM Codes for polysubstance abuse
Decision Criteria
clinical Criteria
- Patient uses multiple substances without dependence symptoms.
Applicable To
- Abuse of multiple substances without dependence
Excludes
- Dependence on multiple substances (F19.20)
Clinical Validation Requirements
- Documentation of multiple substance use without evidence of dependence
- Absence of withdrawal symptoms or tolerance
Code-Specific Risks
- Risk of undercoding if dependence criteria are met but not documented
Coding Notes
- Ensure documentation specifies substances involved to avoid queries.
F19.20 - Polysubstance dependence
Use when the patient meets criteria for dependence on multiple substances.
Applicable To
- Dependence on multiple substances
Excludes
- Abuse of multiple substances without dependence (F19.10)
Clinical Validation Requirements
- Documentation of tolerance, withdrawal, or compulsive use
- Evidence of failed attempts to quit
Coding Notes
Ensure documentation includes evidence of dependence.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Polysubstance Abuse to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F19.10.
Impact
Clinical: Lack of clarity in patient records., Regulatory: Potential for audit issues., Financial: May affect reimbursement accuracy.
Mitigation Strategy
Use specific terms and list substances., Document severity and symptoms.
Impact
Reimbursement: Incorrect coding may lead to lower reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate representation of patient condition.
Mitigation Strategy
Verify documentation for dependence symptoms and use F19.20 if applicable.
Impact
Lack of specific substance documentation can lead to audit findings.
Mitigation Strategy
Ensure all substances are documented with frequency and pattern.
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 Polysubstance Abuse, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Polysubstance Abuse
Use these documentation templates to ensure complete and accurate documentation for Polysubstance Abuse. These templates include all required elements for proper coding and billing.
Patient with polysubstance dependence presenting with withdrawal
Specialty: Addiction MedicineRequired Elements
- Substance list
- Severity of use
- Withdrawal symptoms
- DSM-5 criteria
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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