Accurate diagnosis and coding are crucial in addressing addiction, ensuring proper treatment, research, and healthcare management. For professionals in mental health and related fields, understanding the standardized systems for classifying and coding addiction is essential. This guide provides a comprehensive overview of Addiction Diagnosis Codes, focusing on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). Navigating these codes can be complex, but this resource aims to clarify the process, offering a clear and accessible reference for addiction diagnosis coding.
Understanding DSM-5 and ICD-10-CM in Addiction Diagnosis
The DSM-5 and ICD-10-CM are vital classification systems used worldwide, each serving distinct yet complementary roles in the landscape of mental health and addiction.
The DSM-5, published by the American Psychiatric Association, is primarily a diagnostic tool. It provides detailed criteria for diagnosing mental disorders, including substance use and addictive disorders. It’s the standard reference for clinicians in the United States and is widely used globally to understand and diagnose addiction based on clinical presentation and symptoms.
On the other hand, the ICD-10-CM, a U.S. adaptation of the World Health Organization’s ICD-10, is used for coding and statistical reporting. In healthcare settings, ICD-10-CM codes are used for medical billing, insurance claims, morbidity statistics, and tracking public health trends. For addiction, ICD-10-CM codes translate the diagnostic categories of DSM-5 into a standardized numerical system.
The DSM-5 provides the diagnostic framework, defining disorders like “Alcohol Use Disorder” or “Opioid Use Disorder,” while the ICD-10-CM assigns specific alphanumeric codes to these diagnoses, such as F10.20 for Alcohol Use Disorder, Moderate, or F11.20 for Opioid Use Disorder, Moderate. This coding system is essential for administrative and epidemiological purposes.
Addiction Diagnosis Codes: DSM-5 to ICD-10-CM Crosswalk
The following tables illustrate the DSM-5 recommended ICD-10-CM codes for various substance use disorders. It’s important to note that ICD-10-CM codes were updated on October 1, 2017. The tables below show codes for both periods – before and after this update, as provided in the DSM-5 guidance.
Substance Use Disorders – As Ordered in DSM-5 Classification
| Disorder | DSM-5 Recommended ICD-10-CM Code (Through Sept 30, 2017) | DSM-5 Recommended ICD-10-CM Code (Beginning Oct 1, 2017) |
|---|---|---|
| Avoidant/Restrictive Food Intake Disorder | F50.89 | F50.82 |
| Alcohol Use Disorder, Mild | F10.10 | F10.10 |
| Alcohol Use Disorder, Mild, in early or sustained remission | F10.10 | F10.11 |
| Alcohol Use Disorder, Moderate | F10.20 | F10.20 |
| Alcohol Use Disorder, Moderate, in early or sustained remission | F10.20 | F10.21 |
| Alcohol Use Disorder, Severe | F10.20 | F10.20 |
| Alcohol Use Disorder, Severe, in early or sustained remission | F10.20 | F10.21 |
| Cannabis Use Disorder, Mild | F10.10 | F10.10 |
| Cannabis Use Disorder, Mild, in early or sustained remission | F10.10 | F10.11 |
| Cannabis Use Disorder, Moderate | F12.20 | F12.20 |
| Cannabis Use Disorder, Moderate, in early or sustained remission | F12.20 | F12.21 |
| Cannabis Use Disorder, Severe | F12.20 | F12.20 |
| Cannabis Use Disorder, Severe, in early or sustained remission | F12.20 | F12.21 |
| Phencyclidine Use Disorder, Mild | F16.10 | F16.10 |
| Phencyclidine Use Disorder, Mild, in early or sustained remission | F16.10 | F16.11 |
| Phencyclidine Use Disorder, Moderate | F16.20 | F16.20 |
| Phencyclidine Use Disorder, Moderate, in early or sustained remission | F16.20 | F16.21 |
| Phencyclidine Use Disorder, Severe | F16.20 | F16.20 |
| Phencyclidine Use Disorder, Severe, in early or sustained remission | F16.20 | F16.21 |
| Other Hallucinogen Use Disorder, Mild | F16.10 | F16.10 |
| Other Hallucinogen Use Disorder, Mild, in early or sustained remission | F16.10 | F16.11 |
| Other Hallucinogen Use Disorder, Moderate | F16.20 | F16.20 |
| Other Hallucinogen Use Disorder, Moderate, in early or sustained remission | F16.20 | F16.21 |
| Other Hallucinogen Use Disorder, Severe | F16.20 | F16.20 |
| Other Hallucinogen Use Disorder, Severe, in early or sustained remission | F16.20 | F16.21 |
| Inhalant Use Disorder, Mild | F18.10 | F18.10 |
| Inhalant Use Disorder, Mild, in early or sustained remission | F18.10 | F18.11 |
| Inhalant Use Disorder, Moderate | F18.20 | F18.20 |
| Inhalant Use Disorder, Moderate, in early or sustained remission | F18.20 | F18.21 |
| Inhalant Use Disorder, Severe | F18.20 | F18.20 |
| Inhalant Use Disorder, Severe, in early or sustained remission | F18.20 | F18.21 |
| Opioid Use Disorder, Mild | F11.10 | F11.10 |
| Opioid Use Disorder, Mild, in early or sustained remission | F11.10 | F11.11 |
| Opioid Use Disorder, Moderate | F11.20 | F11.20 |
| Opioid Use Disorder, Moderate, in early or sustained remission | F11.20 | F11.21 |
| Opioid Use Disorder, Severe | F11.20 | F11.20 |
| Opioid Use Disorder, Severe, in early or sustained remission | F11.20 | F11.21 |
| Sedative, Hypnotic, or Anxiolytic Use Disorder, Mild | F13.10 | F13.10 |
| Sedative, Hypnotic, or Anxiolytic Use Disorder, Mild, in early or sustained remission | F13.10 | F13.11 |
| Sedative, Hypnotic, or Anxiolytic Use Disorder, Moderate | F13.20 | F13.20 |
| Sedative, Hypnotic, or Anxiolytic Use Disorder, Moderate, in early or sustained remission | F13.20 | F13.21 |
| Sedative, Hypnotic, or Anxiolytic Use Disorder, Severe | F13.20 | F13.20 |
| Sedative, Hypnotic, or Anxiolytic Use Disorder, Severe, in early or sustained remission | F13.20 | F13.21 |
| Amphetamine-type Substance Use Disorder, Mild | F15.10 | F15.10 |
| Amphetamine-type Substance Use Disorder, Mild, in early or sustained remission | F15.10 | F15.11 |
| Amphetamine-type Substance Use Disorder, Moderate | F15.20 | F15.20 |
| Amphetamine-type Substance Use Disorder, Moderate, in early or sustained remission | F15.20 | F15.21 |
| Amphetamine-type Substance Use Disorder, Severe | F15.20 | F15.20 |
| Amphetamine-type Substance Use Disorder, Severe, in early or sustained remission | F15.20 | F15.21 |
| Cocaine Use Disorder, Mild | F14.10 | F14.10 |
| Cocaine Use Disorder, Mild, in early or sustained remission | F14.10 | F14.11 |
| Cocaine Use Disorder, Moderate | F14.20 | F14.20 |
| Cocaine Use Disorder, Moderate, in early or sustained remission | F14.20 | F14.21 |
| Cocaine Use Disorder, Severe | F14.20 | F14.20 |
| Cocaine Use Disorder, Severe, in early or sustained remission | F14.20 | F14.21 |
| Other or Unspecified Stimulant Use Disorder, Mild | F15.10 | F15.10 |
| Other or Unspecified Stimulant Use Disorder, Mild, In early or sustained remission | F15.10 | F15.11 |
| Other or Unspecified Stimulant Use Disorder, Moderate | F15.20 | F15.20 |
| Other or Unspecified Stimulant Use Disorder, Moderate, In early or sustained remission | F15.20 | F15.21 |
| Other or Unspecified Stimulant Use Disorder, Severe | F15.20 | F15.20 |
| Other or Unspecified Stimulant Use Disorder, Severe, In early or sustained remission | F15.20 | F15.21 |
| Tobacco Use Disorder, Moderate | F17.200 | F17.200 |
| Tobacco Use Disorder, Moderate, in early or sustained remission | F17.200 | F17.201 |
| Tobacco Use Disorder, Severe | F17.200 | F17.200 |
| Tobacco Use Disorder, Severe, in early or sustained remission | F17.200 | F17.201 |
| Other (or Unknown) Substance Use Disorder, Mild | F19.10 | F19.10 |
| Other (or Unknown) Substance Use Disorder, Mild, in early or sustained remission | F19.10 | F19.11 |
| Other (or Unknown) Substance Use Disorder, Moderate | F19.20 | F19.20 |
| Other (or Unknown) Substance Use Disorder, Moderate, in early or sustained remission | F19.20 | F19.21 |
| Other (or Unknown) Substance Use Disorder, Severe | F19.20 | F19.20 |
| Other (or Unknown) Substance Use Disorder, Severe, in early or sustained remission | F19.20 | F19.21 |
Substance Use Disorders – As Ordered in ICD-10-CM Classification
| Disorder | DSM-5 Recommended ICD-10-CM Code (Through Sept 30, 2017) | DSM-5 Recommended ICD-10-CM Code (Beginning Oct 1, 2017) |
|---|---|---|
| Alcohol Use Disorder, Mild | F10.10 | F10.10 |
| Alcohol Use Disorder, Mild, in early or sustained remission | F10.10 | F10.11 |
| Alcohol Use Disorder, Moderate | F10.20 | F10.20 |
| Alcohol Use Disorder, Moderate, in early or sustained remission | F10.20 | F10.21 |
| Alcohol Use Disorder, Severe | F10.20 | F10.20 |
| Alcohol Use Disorder, Severe, in early or sustained remission | F10.20 | F10.21 |
| Opioid Use Disorder, Mild | F11.10 | F11.10 |
| Opioid Use Disorder, Mild, in early or sustained remission | F11.10 | F11.11 |
| Opioid Use Disorder, Moderate | F11.20 | F11.20 |
| Opioid Use Disorder, Moderate, in early or sustained remission | F11.20 | F11.21 |
| Opioid Use Disorder, Severe | F11.20 | F11.20 |
| Opioid Use Disorder, Severe, in early or sustained remission | F11.20 | F11.21 |
| Cannabis Use Disorder, Mild | F12.10 | F12.10 |
| Cannabis Use Disorder, Mild, in early or sustained remission | F12.10 | F12.11 |
| Cannabis Use Disorder, Moderate | F12.20 | F12.20 |
| Cannabis Use Disorder, Moderate, in early or sustained remission | F12.20 | F12.21 |
| Cannabis Use Disorder, Severe | F12.20 | F12.20 |
| Cannabis Use Disorder, Severe, in early or sustained remission | F12.20 | F12.21 |
| Sedative, Hypnotic, or Anxiolytic Use Disorder, Mild | F13.10 | F13.10 |
| Sedative, Hypnotic, or Anxiolytic Use Disorder, Mild, in early or sustained remission | F13.10 | F13.11 |
| Sedative, Hypnotic, or Anxiolytic Use Disorder, Moderate | F13.20 | F13.20 |
| Sedative, Hypnotic, or Anxiolytic Use Disorder, Moderate, in early or sustained remission | F13.20 | F13.21 |
| Sedative, Hypnotic, or Anxiolytic Use Disorder, Severe | F13.20 | F13.20 |
| Sedative, Hypnotic, or Anxiolytic Use Disorder, Severe, in early or sustained remission | F13.20 | F13.21 |
| Cocaine Use Disorder, Mild | F14.10 | F14.10 |
| Cocaine Use Disorder, Mild, in early or sustained remission | F14.10 | F14.11 |
| Cocaine Use Disorder, Moderate | F14.20 | F14.20 |
| Cocaine Use Disorder, Moderate, in early or sustained remission | F14.20 | F14.21 |
| Cocaine Use Disorder, Severe | F14.20 | F14.20 |
| Cocaine Use Disorder, Severe, in early or sustained remission | F14.20 | F14.21 |
| Amphetamine-type Substance Use Disorder, Mild | F15.10 | F15.10 |
| Amphetamine-type Substance Use Disorder, Mild, in early or sustained remission | F15.10 | F15.11 |
| Amphetamine-type Substance Use Disorder, Moderate | F15.20 | F15.20 |
| Amphetamine-type Substance Use Disorder, Moderate, in early or sustained remission | F15.20 | F15.21 |
| Amphetamine-type Substance Use Disorder, Severe | F15.20 | F15.20 |
| Amphetamine-type Substance Use Disorder, Severe, in early or sustained remission | F15.20 | F15.21 |
| Other or Unspecified Stimulant Use Disorder, Mild | F15.10 | F15.10 |
| Other or Unspecified Stimulant Use Disorder, Mild, In early or sustained remission | F15.10 | F15.11 |
| Other or Unspecified Stimulant Use Disorder, Moderate | F15.20 | F15.20 |
| Other or Unspecified Stimulant Use Disorder, Moderate, In early or sustained remission | F15.20 | F15.21 |
| Other or Unspecified Stimulant Use Disorder, Severe | F15.20 | F15.20 |
| Other or Unspecified Stimulant Use Disorder, Severe, In early or sustained remission | F15.20 | F15.21 |
| Phencyclidine Use Disorder, Mild | F16.10 | F16.10 |
| Phencyclidine Use Disorder, Mild, in early or sustained remission | F16.10 | F16.11 |
| Phencyclidine Use Disorder, Moderate | F16.20 | F16.20 |
| Phencyclidine Use Disorder, Moderate, in early or sustained remission | F16.20 | F16.21 |
| Phencyclidine Use Disorder, Severe | F16.20 | F16.20 |
| Phencyclidine Use Disorder, Severe, in early or sustained remission | F16.20 | F16.21 |
| Other Hallucinogen Use Disorder, Mild | F16.10 | F16.10 |
| Other Hallucinogen Use Disorder, Mild, in early or sustained remission | F16.10 | F16.11 |
| Other Hallucinogen Use Disorder, Moderate | F16.20 | F16.20 |
| Other Hallucinogen Use Disorder, Moderate, in early or sustained remission | F16.20 | F16.21 |
| Other Hallucinogen Use Disorder, Severe | F16.20 | F16.20 |
| Other Hallucinogen Use Disorder, Severe, in early or sustained remission | F16.20 | F16.21 |
| Tobacco Use Disorder, Moderate | F17.200 | F17.200 |
| Tobacco Use Disorder, Moderate, in early or sustained remission | F17.200 | F17.201 |
| Tobacco Use Disorder, Severe | F17.200 | F17.200 |
| Tobacco Use Disorder, Severe, in early or sustained remission | F17.200 | F17.201 |
| Inhalant Use Disorder, Mild | F18.10 | F18.10 |
| Inhalant Use Disorder, Mild, in early or sustained remission | F18.10 | F18.11 |
| Inhalant Use Disorder, Moderate | F18.20 | F18.20 |
| Inhalant Use Disorder, Moderate, in early or sustained remission | F18.20 | F18.21 |
| Inhalant Use Disorder, Severe | F18.20 | F18.20 |
| Inhalant Use Disorder, Severe, in early or sustained remission | F18.20 | F18.21 |
| Other (or Unknown) Substance Use Disorder, Mild | F19.10 | F19.10 |
| Other (or Unknown) Substance Use Disorder, Mild, in early or sustained remission | F19.10 | F19.11 |
| Other (or Unknown) Substance Use Disorder, Moderate | F19.20 | F19.20 |
| Other (or Unknown) Substance Use Disorder, Moderate, in early or sustained remission | F19.20 | F19.21 |
| Other (or Unknown) Substance Use Disorder, Severe | F19.20 | F19.20 |
| Other (or Unknown) Substance Use Disorder, Severe, in early or sustained remission | F19.20 | F19.21 |
| Avoidant/Restrictive Food Intake Disorder | F50.89 | F50.82 |
Navigating Severity and Remission in Addiction Coding
Within both DSM-5 and ICD-10-CM coding for substance use disorders, the concepts of severity and remission are critical. Severity, typically categorized as mild, moderate, or severe, is determined by the number of diagnostic criteria met by an individual. This reflects the impact of the substance use on the person’s life and functioning.
- Mild: Indicates a lower level of problematic substance use.
- Moderate: Suggests a more significant impact, with more criteria being met.
- Severe: Represents the most serious form of substance use disorder, with a high number of criteria met and significant disruption in life.
Remission is another crucial aspect, indicating the status of the substance use disorder in terms of abstinence or reduced use.
- Early Remission: Applies when the criteria for substance use disorder have not been met for at least 3 months but less than 12 months, with the exception of craving.
- Sustained Remission: Is used when the criteria for substance use disorder have not been met for 12 months or longer, again, with the exception of craving.
These specifiers for severity and remission are vital for accurate diagnosis and coding, as they influence the specific ICD-10-CM code assigned. For instance, within Alcohol Use Disorder, the code will differ based on whether it’s mild, moderate, or severe, and whether the individual is in early or sustained remission. This level of detail allows for nuanced understanding and tracking of addiction disorders.
Utilizing Addiction Diagnosis Codes in Practice
For healthcare professionals, accurate use of addiction diagnosis codes is paramount for several reasons:
- Effective Communication: Standardized codes ensure clear communication among healthcare providers, facilitating better patient care coordination.
- Billing and Reimbursement: Correct ICD-10-CM codes are essential for insurance claims processing and healthcare reimbursement.
- Data Collection and Epidemiology: Accurate coding contributes to reliable statistical data on addiction prevalence, trends, and treatment outcomes, which informs public health strategies and research.
- Clinical Documentation: Using these codes as part of clinical documentation helps in maintaining organized and standardized patient records.
When coding for addiction, always refer to the most current versions of DSM-5 and ICD-10-CM guidelines. Pay close attention to the specific criteria for each disorder, the levels of severity, and remission status. Accuracy in coding not only ensures administrative efficiency but also contributes to better understanding and management of addiction on both individual and population levels.
Conclusion
Understanding and correctly applying addiction diagnosis codes from DSM-5 and ICD-10-CM is a fundamental skill for professionals working in addiction treatment and mental health. This guide provides a starting point for navigating these codes. For detailed information and the most up-to-date guidelines, always refer to the official DSM-5 and ICD-10-CM publications and resources. Accurate coding is a critical component of effective addiction care, contributing to better treatment, research, and understanding of this complex health issue.
