"Z72.0" VS "F17.210" Which Is More Appropriate? Nicotine Dependence In PT W COPD

kbeau78@gmail.comkbeau78@gmail.com
in Home Care Coding General
Good Morning! I have always applied F17.210, Nicotine dependence, cigarettes, uncomplicated when MD states tobacco abuse. Case manager states to use Z72.0 Tobacco Use, NOS. What do ya'll use? Thanks!

Comments

  • lisa.sharpe@sanfordhealth.orglisa.sharpe@sanfordhealth.org
    edited May 2017
    You're correct - Tobacco Use/abuse and "smoker" are coded to F17.21-

    Lisa Sharpe, HCS-D
    Coding Specialist
    Sanford Bemidji HomeCare and Hospice
    3201 Pine Ridge Ave NW RT# 10800
    Bemidji MN 56601
    Phone 218-333-5764  Fax 218-333-6017
    lisa.sharpe@sanfordhealth.org
  • kcarterkcarter
    Coding tips indicate if a physician documents "smoker" to use F17.20-.

    There is no guidance that I am aware of to code F17.2- if tobacco use only is documented.

    Not all "tobacco use" would be equivalent to "smoker" or "former smoker." (ie you could abuse or use tobacco in other ways than smoking)
  • jgonzales@phri.comjgonzales@phri.com
    We used F17.210 if cigarette type was mentioned. If only tobacco use, F17.200.
  • lisa.sharpe@sanfordhealth.orglisa.sharpe@sanfordhealth.org
    edited May 2017
    You're right - I was assuming tobacco abuse meant smoking because it was the F17.210 she was referencing. If it's stated as tobacco use/abuse and not specified as "smoker" than use F17.20-

    Lisa Sharpe, HCS-D
    Coding Specialist
    Sanford Bemidji HomeCare and Hospice
    3201 Pine Ridge Ave NW RT# 10800
    Bemidji MN 56601
    Phone 218-333-5764  Fax 218-333-6017
    lisa.sharpe@sanfordhealth.org
  • AlifAlif
    edited May 2017
    I remember reading somewhere , to only use the F17 codes if it specifically says dependence. If it doesn't we are to use Z72.0

    I can't seem to find the source now. It was either here or in one of the Diagnosis Coding Pro newsletters. Does anyone remember this?
  • kbeau78@gmail.comkbeau78@gmail.com
    That would be great if I could find that information! Thanks for the great input!
  • consultingbykristinconsultingbykristin
    edited May 2017
    I would NOT use F17.xxx without clear documentation from the provider that abuse or dependence exists. If they document tobacco use disorder or tobacco use, I might code to the appropriate F17 code for use.

    However, if they only state patient is a smoker, I use Z72.0. Use, abuse, dependence ALL require physician's clinical judgement that such a disorder exists.


    Per the Official Guidelines

    -If both use and abuse are documented, assign only the code for abuse
    -If both abuse and dependence are documented, assign only the code for dependence
    -If use, abuse and dependence are all documented, assign only the code for dependence
    -If both use and dependence are documented, assign only the code for dependence.


    So report use when that's all that's documented. Abuse trumps use, dependence trumps them all. But only if it's documented.

    These codes require clinical judgment. If they aren't stating dependence, in my opinion, we would be making an assumption and potentially coding incorrectly.

    The guidelines go on to state:

    As with all other diagnoses, the codes for psychoactive substance use (F10.9-, F11.9-, F12.9-, F13.9-, F14.9-, F15.9-, F16.9-) should only be assigned based on provider documentation and when they meet the definition of a reportable diagnosis (see Section III, Reporting Additional Diagnoses). The codes are to be used only when the psychoactive substance use is associated with a mental or behavioral disorder, and such a relationship is documented by the provider.
  • lisa.sharpe@sanfordhealth.orglisa.sharpe@sanfordhealth.org
    edited May 2017
    The coding tip at Z72.0 states "If the physician documents 'smoker', use F17.2- code instead. The description at F17.20- is for Tobacco use disorder, mild, moderate, and severe. The coding tip at F17.210 directs us to choose this code if the MD documents 'smoker' or tobacco/nicotine dependence.

    Lisa Sharpe, HCS-D
    Coding Specialist
    Sanford Bemidji HomeCare and Hospice
    3201 Pine Ridge Ave NW RT# 10800
    Bemidji MN 56601
    Phone 218-333-5764  Fax 218-333-6017
    lisa.sharpe@sanfordhealth.org
  • kbeau78@gmail.comkbeau78@gmail.com
    edited May 2017
    I agree. If the doctor states ie: long time smoker for past 54 years, or
    long time smoker, so many packs a year, F17.20 is more appropriate.
  • MperrottaMperrotta

    If the patient quit smoking with most recent hospitalization- do you still use F17- ? Is there a time frame to use the active smoking code?

  • MichelleBMichelleB

    How many people "quit" in the hospital just to go home and smoke. I still use F17. Now if they have stayed quit by recert time, I change it to hx of.

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