By Katrina Moultrie, BS, CPC, CFPC, CPEDC, CPC-I
During TXCC’s 2018 Coding Updates Seminar held on January 19th, an audience member posed the question “How do you code for the use of E-Cigarettes?” In a room full of coders, the answer seemed so clear … just pick the code for nicotine/tobacco dependence someone offered… yet the fact is many E-Cigarette users do so to replace their smoking habit with a non-nicotine alternative. It is important for coders to understand that the jargon of “E-Cigarette” extends beyond a device that contains a nicotine product and unfortunately, ICD-10-CM does not provide guidelines or a classification for this trend.
E-Cigarettes or electronic delivery systems are defined by the National Institutes of Health’s National Institute on Drug Abuse “battery-operated devices that people use to inhale an aerosol, which typically contains nicotine (though not always), flavorings, and other chemicals.”
The U.S. Food and Drug Administration recently finalized a rule that extends its regulatory authority to all “products meeting the statutory definition of “tobacco product,” except accessories of the newly deemed tobacco products, to be subject to the Federal Food, Drug, and Cosmetic Act (the FD&C Act), as amended by the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act)” as part of its goal to improve public health.
E-Cigarettes that supposedly contain no nicotine, just flavoring and other chemicals, can pose unidentified health risks making the coding surrounding E-Cigarette use problematic. From the 2016 Surgeon General’s Report: E-Cigarette Use Among Youth and Young Adults, “Users of e-cigarettes risk respiratory exposure to a variety of aerosolized chemicals, including solvents and flavorants added intentionally to e-liquids, adulterants added unintentionally, and other toxicants produced during the heating/aerosolization process”
THE CODING CONUNDRUM SOLVED:
So how do we code for a patient who presents with respiratory symptoms and the provider would like to capture the patient’s consistent use of an E-Cigarette (designated as nicotine-free) as a probable cause? The correct code for the individual patient will be selected based on provider documentation in the medical record.
If documentation states that the patient is using a non-nicotine E-Cigarette, be aware that currently ICD-10-CM does not provide a code to report. However, the chemicals, additives and flavoring in a non-nicotine electronic cigarette are currently listed as “potentially harmful,” allowing the opportunity to report a poisoning, drug use or other code when the physician specifically lists the harmful nature of the chemical(s) or adverse outcome of patient contact.
How do coders of excellence act as true provider support to help guide specific documentation in an area that currently does not contain guidance?
Query and educate your provider by using the following questions as a prompt to better documentation:
1. Does the E-Cigarette contain nicotine?
- Suggest a code from the many tobacco dependence options
- F17.200 – Nicotine dependence, unspecified, uncomplicated
- F17.201 – Nicotine dependence, unspecified, in remission
- F17.210 – Nicotine dependence, cigarettes, uncomplicated
- F17.211 – Nicotine dependence, cigarettes, in remission
- F17.290 – Nicotine dependence, other tobacco product, uncomplicated
- F17.291 – Nicotine dependence, other tobacco product, in remission
2. Is the patient a former smoker?
- Suggest a code for history of nicotine dependence
- Z87.891 – Personal history of nicotine dependence
- This situation may occur when a patient is utilizing a non-nicotine E-Cigarette to stop using tobacco products.
3. What are the chemicals, additives, and flavoring in the E-Cigarette?
- Suggest a code to capture the specific chemical if known
- T65.891 – Toxic effect of other specified substances, accidental (unintentional)
In closing, it seems practical that with over 26 pages of ICD-10 guidelines, a straightforward answer would appear somewhere within this great book of diseases. However, this seminar question proves once again that professional coders require the skill sets, critical thinking, research tenacity and communication skills to take a seemingly simple scenario and develop it into accurate and compliant reflection of a patient’s health condition.