Coding alcohol and drug abuse and dependence

Alcohol and drug abuse and dependence coding are classified into psychiatric section of ICD and the treatment for these conditions require drug or alcohol rehab. The most confusing part of abuse and dependence coding in ICD is the fifth digit for the type of abuse or dependence. According to coding clinic the fifth digit should be assigned depending upon physician documentation and not on the time frame or pattern of drug or alcohol abuse. The following are the options for fifth digit assignment.

continuous
episodic
remission
unspecified

The selection of fifth digit is based on physician documentation of the words like "continuous", "episodic", and "remission." Even if there is documentation of abuse or dependence of drug or alcohol in the past and still the patient is using the drug/alcohol we cannot assume it as continuous abuse. It should be coded as unspecified abuse as long as the physician documents it as "continuous abuse."

If there is history of alcohol or drug abuse and there is no other documentation of abuse then according to coding clinic we can code it as remission.