HCC Coding: Identifying and Correctly Documenting Alcohol Use Disorders

The severity of a substance use disorder – mild, moderate, or severe – is based on the number of criteria met. Possibly, a composite system could be developed for ICD-11 such that the key diagnoses of hazardous use, harmful use and alcohol dependence feature in F10.x, which would be used when an alcohol use disorder is the presenting condition. An expanded hierarchical classification system of alcohol involvement along the lines proposed by Touquet and Harris could then be employed when the presenting disorder is a physical illness or an injury. Several factor analytic studies of alcohol abuse and dependence have been conducted, some using treatment samples or samples predefined as dependent (e.g., Feingold and Rounsaville 1995; Mohan et al. 1995; Morgenstern et al. 1994). These studies showed a single factor with loadings (for more information, see the sidebar on p. 13) for both dependence and abuse items, suggesting that abuse and dependence are manifestations of a single condition.

Can you treat an alcoholic?

Does Treatment Work? The good news is that no matter how severe the problem may seem, most people with AUD can benefit from some form of treatment. Research shows that about one-third of people who are treated for alcohol problems have no further symptoms 1 year later.

Validity studies indicate that DSM–IV and ICD–10 alcohol dependence diagnoses have good validity, but the validity for alcohol abuse/harmful use is much lower. The hierarchical relationship of alcohol abuse to dependence may contribute to the reliability and validity problems of abuse, an issue likely to be addressed when work begins on DSM–V. DSM–III–R represented a considerable departure from DSM–III in many respects, including the categorization of alcohol use disorders.

alcohol dependence criteria

The Fetal Alcohol Spectrum Disorders Prevention Program is a CDC-funded initiative of ACOG. There are now 25 new ICD-10 codes for substance use disorders (SUD) which all LCSWs who work with patients diagnosed with these disorders should know. The term ‘alcohol dependence’ has replaced ‘alcoholism’ as a term in order that individuals do not internalize the idea of cure and disease, but can approach alcohol as a chemical they may depend upon to cope with outside pressures. In the United States, the Diagnostic and Statistical Manual of Mental Disorders (DSM) is the most common diagnostic guide for substance use disorders, whereas most countries use the International Classification of Diseases (ICD) for diagnostic (and other) purposes.

What is code Z63 32?

2023 ICD-10-CM Diagnosis Code Z63. 32: Other absence of family member.

Because these results were consistent across studies using different diagnostic interviews, the results can be considered attributable to the diagnostic criteria themselves rather than to a particular assessment procedure. Most of the changes to mental health codes relate to new specifiers, which occur after the decimal point of the parent code, for substance abuse disorders. Psychologists can now select a specific ICD-10-CM code when a patient is in remission from abuse of a variety of substances, including alcohol, opioids and cannabis. In principle, this could work well, if it were routinely applied to injury cases and if diagnostic codes were recorded to the fourth character.

Coding guidelines for alcohol use, abuse and dependence

Coming only 7 years later, the transition from DSM–III–R to DSM–IV (APA 1994) reflected a much more conservative process; compelling evidence for improvement was required before changes were adopted. Thus, the DSM–IV criteria for alcohol abuse and dependence were similar to the corresponding DSM–III–R criteria. A concern that the DSM–III–R definition of alcohol dependence had been too broad whereas abuse had been defined too narrowly led to some restriction on the DSM–IV dependence category and addition of criteria to the DSM–IV abuse category (table 2). The DSM–IV criteria for alcohol dependence and abuse were used in the U.S. National Longitudinal Alcohol Epidemiologic Survey (NLAES) (Grant 1997) of 42,862 subjects, which was sponsored by NIAAA and conducted in the early 1990s.

alcoholism icd 10

It was argued that not all elements may be present in every case, but the picture is sufficiently regular and coherent to permit clinical recognition. The syndrome was also considered to exist in degrees of severity rather than as a categorical absolute. Thus, the proper question is not ‘whether a person is dependent on alcohol’, but ‘how far along the path of dependence has a person progressed’.

Enhancing the ICD System in Recording Alcohol’s Involvement in Disease and Injury

Factor analysis involves analyzing the relationships between a set of variables to determine if they appear to be measuring one or more latent variables, called factors. A subset of items more related to each other than to other variables in a data set suggests that this subset of items is measuring an underlying construct or condition. The relationship of any item to a particular factor is indicated by its factor loading. Latent class analysis uses a latent variable with mutually exclusive categories to represent subpopulations in a sample, where subpopulation membership is not observed but inferred from the data. Variables form symptom profiles that are explained by the existence of a small number of mutually exclusive classes.

However, consistent reliability findings from studies using different diagnostic interviews indicate more general information about the diagnosis. Cross-method comparisons indicated excellent agreement for alcohol dependence, supporting the validity of this diagnostic category. However, cross-method agreement was consistently lower for abuse/harmful use. Further examination of the abuse/harmful use category or its individual criteria in three of these studies (Cottler et al. 1997; Hasin et al. 1996b; Pull et al. 1997) showed that the reliability of abuse/harmful use improved when diagnosed as an independent category.

F10.2 Alcohol dependence

Both DSM–III–R and DSM–IV require only one criterion to diagnose abuse, and both include recurrent use of alcohol in physically hazardous situations as one of the abuse criteria. This criterion accounts for slightly less than 50 percent of all abuse cases in the general population (Hasin et al. 1999; Hasin and Paykin 1999a, b). However, the other abuse criteria differ considerably between DSM–III–R and DSM–IV (table 2). In ICD–10, the harmful use criteria consist of mental, physical, or social harm from drinking. An important commonality of abuse/harmful use across the classification systems is that abuse cannot be diagnosed in a person who currently meets criteria for dependence. Hence, abuse is a residual category for current disorders in DSM–III–R, DSM–IV, and ICD–10.

  • Good reliability is a requirement for good validity, but a reliable measure may not indicate the condition of interest.
  • Alcohol-related emergency presentations including injuries are typically classified using the primary code for the specific disease or injury.
  • An additional code, for avoidant/restrictive food intake disorder, has been moved from “Other specified eating disorder” to “Other eating disorder,” classifying it alongside Binge eating disorder (F50.81).
  • Further examination of the abuse/harmful use category or its individual criteria in three of these studies (Cottler et al. 1997; Hasin et al. 1996b; Pull et al. 1997) showed that the reliability of abuse/harmful use improved when diagnosed as an independent category.

Hence, determining the reliability of diagnostic procedures (or specific criteria or symptoms) is important. The contemporary definition of alcohol dependence is still based upon early research. A BAC of 0.09% https://www.excel-medical.com/5-tips-to-consider-when-choosing-a-sober-living-house/ to 0.25% causes lethargy, sedation, balance problems and blurred vision. A BAC of 0.18% to 0.30% causes profound confusion, impaired speech (e.g. slurred speech), staggering, dizziness and vomiting.

However, among those that did, the reliability of abuse/harmful use was notably lower than the reliability of dependence (Bucholz et al. 1994; Canino et al. 1999; Chatterji et al. 1997; Hasin et al. 1996c, 1997a). Reliability studies involve comparing the agreement between pairs of assessments made on a series of patients. An inter-rater reliability study shows the agreement between diagnoses given by an active interviewer and by an observer. The more common and informative design is the test–retest reliability study, in which a series of subjects are independently evaluated with a particular diagnostic interview by two or more interviewers. In this type of study, one interviewer completes a diagnostic interview and then a second “blind” interviewer (not present in the original evaluation) administers the same interview without knowing the results of the first interview. Low reliability indicates that results of the measure are inconsistent, thus limiting validity and reducing a measure’s ability to show a relationship between what is being measured and other variables, including causes, treatment responses, and consequences.

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