Cracking the Code
Medical Condition due to Psychoactive Substance Use, Abuse, and Dependence
Medical coders will encounter cases when patients have a substance use, abuse, or dependence disorder with an associated medical condition. Medical conditions due to substance use, abuse, and dependence are NOT classified as substance-induced disorders; these are two completely distinct categories that sound similar but have different diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).
Substance-induced disorders occur when a person has immediate effects of substance use (intoxication) and immediate effects of discontinuing a substance (withdrawal). In contrast, substance use disorders involve negative consequences of continued and frequent use of substances. When a provider specifically documents that a patient has a condition due to substance use, abuse, or dependence, it is appropriate to assign the diagnosis code for the medical condition as directed by the Alphabetic Index AND the appropriate psychoactive use, abuse, or dependence code.