Alcohol Withdrawal: Alcohol Dependence, or Alcohol Abuse?

One of our auditors brought the following two Coding Clinics to our attention, writing: “This whole business is still a bit confusing – one usually could not have alcohol dependence without alcohol abuse, but this is where we are.”

We agree. If you drank alcohol to the point where you withdraw without it, it is pretty clearly abuse. But we have to query, based on the below:

Alcohol abuse and alcohol withdrawal

ICD-10-CM/PCS Coding Clinic, Second Quarter ICD-10 2015 Page: 15 Effective with discharges: July 6, 2015 Question: The Index entry for Alcohol, withdrawal, leads to code F10.239, Alcohol dependence with withdrawal. However, only alcohol abuse is documented by the physician. In ICD-10-CM, how is alcohol abuse with alcohol withdrawal coded?

Answer: In ICD-10-CM, alcohol withdrawal is categorized as alcohol dependence, by default. The classification provides a combination code for alcohol dependence with alcohol withdrawal. Therefore query the provider for clarification, when alcohol abuse and alcohol withdrawal are both documented in the health record.

Alcohol abuse & alcohol withdrawal

ICD-10-CM/PCS Coding Clinic, First Quarter ICD-10 2018 Page: 16 Effective with discharges: February 18, 2018 Question: A 21-year-old was admitted due to alcohol abuse and the provider documented alcohol withdrawal. The physician was queried and clarified that the patient had alcohol withdrawal, but was not alcohol dependent. We are not able to code a diagnosis of alcohol withdrawal without dependence. How can we accurately code this case?

Answer: In ICD-10-CM, alcohol withdrawal is categorized as alcohol dependence. ICD-10-CM does not classify alcohol withdrawal with alcohol abuse. If the physician has been queried and confirmed alcohol abuse, rather than dependence, code only "alcohol abuse" and do not assign a code for withdrawal.

Frankly? It is enough to drive us to drink.