ICD-10 Coding for Alcohol Use in Remission(F10.11, F10.21)
Complete ICD-10-CM coding and documentation guide for Alcohol Use in Remission. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Alcohol Use in Remission
F10.1-F10.2Primary Range
Mental and behavioral disorders due to use of alcohol, in remission
This range includes codes for alcohol use disorders in remission, distinguishing between abuse and dependence.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| F10.11 | Alcohol abuse, in remission | Use when the patient has a history of mild alcohol use disorder and is currently in remission. |
|
| F10.21 | Alcohol dependence, in remission | Use when the patient has a history of moderate to severe alcohol use disorder and is currently in remission. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for alcohol use in remission
Essential facts and insights about Alcohol Use in Remission
Primary ICD-10-CM Codes for alcohol use in remission
Decision Criteria
documentation Criteria
- Explicit documentation of 'in remission' by the provider
Applicable To
- Mild alcohol use disorder in remission
Excludes
- Alcohol dependence in remission (F10.21)
Clinical Validation Requirements
- Provider documentation stating 'in remission'
- Absence of current DSM-5 criteria for alcohol use disorder
Code-Specific Risks
- Misclassification if provider documentation is not explicit
Coding Notes
- Ensure provider documentation explicitly states 'in remission'.
F10.21 - Alcohol dependence, in remission
Use when the patient has a history of moderate to severe alcohol use disorder and is currently in remission.
Applicable To
- Moderate to severe alcohol use disorder in remission
Excludes
- Alcohol abuse in remission (F10.11)
Clinical Validation Requirements
- Provider documentation stating 'in remission'
- Absence of current DSM-5 criteria for alcohol use disorder
Coding Notes
Ensure provider documentation explicitly states 'in remission'.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Blood alcohol level, unspecified
Y90.9Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Alcohol Use in Remission to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F10.11.
Impact
Clinical: Misrepresentation of patient's current status., Regulatory: Potential audit issues due to incorrect coding., Financial: Possible claim denials or reduced reimbursement.
Mitigation Strategy
Educate providers on the importance of documenting remission status., Implement regular chart audits to ensure compliance.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records and quality reporting.
Mitigation Strategy
Always confirm 'in remission' status with provider documentation.
Impact
Failure to document 'in remission' can lead to audit findings.
Mitigation Strategy
Ensure all providers are trained to document remission status explicitly.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Alcohol Use in Remission, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Alcohol Use in Remission
Use these documentation templates to ensure complete and accurate documentation for Alcohol Use in Remission. These templates include all required elements for proper coding and billing.
Routine follow-up for a patient in remission
Specialty: Primary CareRequired Elements
- Patient history
- Current status
- Provider assessment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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