Friday, December 30, 2011

ICD-9 Coding: Welcome the New Year with a Reminder of Alcohol Related Diagnoses

Ensure that you choose the accurate diagnosis code when alcohol is a factor of an ED visit

The New Year is approaching and with it comes an upsurge in alcohol-related presentations to the ED. Even though a lot of presenting problems are injuries or illnesses to which alcohol was a reason, it may be worth reviewing the numerous alcohol-related diagnoses that are available and when are they applicable in the ED setting. Read this article to know what ICD-9 codes apply for stress-free medical coding.

Take a look at some common patient types:

1. Patients who are brought in as they are impaired

It is not unusual for a highly intoxicated person to be brought to the ED by concerned friends, parents, or law enforcement officers as the patient seems to be unresponsive or dangerously intoxicated.

First let’s consider the patient, for whom no other diagnosis is probable, has come under medical care owing to the maladaptive effect of a drug on which he is not reliant on, and that he has taken on his own initiative to the damage of his health or social functioning, for instance a New Year’s Eve or a Super Bowl party. In this case, the patient has no history of alcohol dependency, but seems to have considerably exceeded his limit on this occasion.

ICD-9 codes that might apply are as following:

1. 305.0 (Nondependent alcohol abuse)
2. 305.00 (Nondependent alcohol abuse, unspecified drinking behaviour)
3. 305.01 (Nondependent alcohol abuse, continuous drinking behaviour)
4. 305.02 (Nondependent alcohol abuse, episodic drinking behaviour)
5. 305.03 (Nondependent alcohol abuse, in remission)

2. Patients whose condition is caused by long time alcohol abuse

The other end of the range is the long time alcohol abuser whose medical problems are directly credited to that history. Probable presentations involve hallucinations, seizures or delirium tremens. These patients may or may not be impaired at the time of their visit.

Frequently seen ED presentations can be reported with the following diagnosis ICD-9 codes:






  • 291 (Alcohol induced mental disorders)






  • 291.0 (Alcohol withdrawl delirium)






  • 291.1 (Alcohol induced persisting amnestic disorder)






  • 291.2 (Alcohol-induced persisting dementia)






  • 291.3 (Alcohol-induced psychotic disorder with hallucinations)






  • 291.4 (Idiosyncratic alcohol intoxication)






  • 291.5 (Alcoholic-induced psychotic disorder with delusions)






  • 291.8 (Other specified alcohol-induced mental disorders)






  • 291.81 (Alcohol withdrawl)






  • 291.9 (Unspecified alcohol-induced mental disorders)

  • Is it time for an Intervention? Deliberate behavior change intervention ICD-9 codes

    Occasionally the trip to the ED for an alcohol-related injury turns into a chance for a screening and intervention to occur. Consider the patient who fell down the stairs because they were intoxicated or when alcohol appears to have contributed to MVA related injuries. Even though a busy ED is not the best place for this service, check the chart documentation to find if there is support for reporting the following ICD-9 codes:






  • 99408 {Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes (Do not report services of less than 15 minutes with 99408}






  • 99409 {greater than 30}


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