What is a dependency in coding

2.4.5 Present ICD-10 diagnoses by substance class (F10 - F19)

2.4.5

Present ICD-10 diagnoses by substance class (F10 - F19)

Explanation of the diagnosis: Both substance-related and other diagnoses are recorded in the KDS-F according to the ICD-10 guidelines and refer to the situation at the start of care / treatment. Even if a final diagnosis cannot be made immediately upon admission, the entries should always reflect the status at the beginning of the care / treatment. A diagnosis for a substance class necessarily presupposes that it has ever been consumed in life (Item 2.4.1).

2.4.5.X.1

Current diagnosis (s)

A current ICD-10 diagnosis is assigned for each substance class, provided that the prerequisites for this are clearly given from the point of view of the practitioner / supervisor (see below for coding / diagnosis information). The diagnostic guidelines for a correct diagnosis must be strictly observed.

2.4.5.X.2

If there is currently no diagnosis, possibly an earlier diagnosis

Even if no ICD-10 diagnosis can currently be issued to the knowledge of the institution (this will mainly be the case because the time criterion of 1 year is not met), previous care / treatments of the client / patient could The relevant diagnoses must be known, which must be stated here.

2.4.5.X.3

Age at the start of the fault

The age given by the client / patient as the beginning of his / her problem development must be given here. This will often be the case when there is a certain regularity of consumption, which leads to the development of problem dynamics.

 

 

Notes on assigning the ICD-10 diagnosis (digit 4 + digit 5) from chapter F1:

Under 2.4.5.X.1 and 2.4.5.X.2, according to the latest version of the ICD - during the current revision of the KDS, the ICD-10 (Dilling et al., 2005) - “Mental and behavioral disorders by psychotropic substances ”(F10-F19). Positions 1 to 3 are given, e.g. F10 for an alcohol disorder, positions 4 and 5 are to be coded for the relevant substances. They characterize the clinical appearance of the respective disorder.

The digits 1 to 3 are to be coded as follows:

F10.- Mental and behavioral disorders due to alcohol

F11. Mental and behavioral disorders due to opioids

F12.- Mental and behavioral disorders due to cannabinoids

F13.- Mental and behavioral disorders caused by sedatives or hypnotics

F14.- Mental and behavioral disorders due to cocaine

F15. Mental and behavioral disorders due to other stimulants, including caffeine

F16. Mental and behavioral disorders due to hallucinogens

F17. Mental and behavioral disorders due to tobacco

F18.- Mental and behavioral disorders due to volatile solvents

F19. Mental and behavioral disorders due to multiple substance use and consumption of other psychotropic substances

 

The most important codes of digit 4 are x.1 = harmful use and x.2 = addiction syndrome. Further codes of digit 4 can be found in the current version of the ICD-10 (Dilling et al., 2005). In the context of the DSHS, however, only the two codes 1 and 2 for harmful use and dependency syndrome are collected for the 4th digit in the KDS-F.

F1x.1 Harmful use (according to ICD-10, Dilling et al., 2005)

Consumption of psychotropic substances, which leads to damage to health. This can occur as a physical disorder, for example in the form of hepatitis after self-injection of the substance or as a psychological disorder e.g. as a depressive episode due to massive alcohol consumption.

The terms “harmful use” and “abuse of psychotropic substances” are used synonymously.

Since the ICD-10 does not specify a time reference for the diagnosis “harmful use”, the following time frame is used as a basis for coding: The utility model has been in existence for at least four weeks or has occurred repeatedly in the last 12 months.

Diagnostic guidelines for harmful use

The diagnosis requires actual damage to the mental or physical health of the consumer. Harmful consumer behavior is often criticized by others and also often has different negative social consequences. The rejection of consumer behavior or of a certain substance by other persons or an entire society is not proof of harmful use, nor are any negative social consequences, e.g. imprisonment or marital problems.

Acute intoxication (...) or a "hangover" alone does not prove the "damage to health" which is necessary for the diagnosis of harmful use. Harmful use cannot be diagnosed in the case of an addiction syndrome (F1x.2), a psychotic disorder (F1x.5) or other specific alcohol- or substance-related disorders.

Exclusion: harmful use of non-addictive substances (F55).

 

F1x.2 Dependency Syndrome

A group of behavioral, cognitive, and physical phenomena that develop after repeated substance use. Typically, there is a strong desire to ingest the substance, difficulty controlling use, and prolonged use of the substance despite harmful consequences. Substance use is given priority over other activities and obligations. An increase in tolerance and sometimes a physical withdrawal syndrome develops.

 

Diagnostic guidelines for dependence

A definite diagnosis of addiction should only be made if at any time during the past year three or more of the following criteria were present:

 

1 A strong desire or some kind of compulsion to use psychotropic substances.

2 Reduced ability to control the beginning, the end and the amount of consumption.

3 A physical withdrawal syndrome (see F1x.3 and F1x.4) upon cessation or reduction of consumption, evidenced by the substance-specific withdrawal symptoms or by the consumption of the same or a closely related substance in order to alleviate or avoid withdrawal symptoms.

4 Evidence of tolerance. In order to induce the effects of the psychotropic substance originally achieved through lower doses, increasingly higher doses are required (clear examples of this are the daily doses of alcohol and opiate addicts, which would lead to severe impairment or even death in users who did not develop tolerance).

5 Progressive neglect of other pleasures or interests in favor of substance use, increased time expended to obtain the substance, to consume it or to recover from the consequences.

6 Persistent substance use despite evidence of clear harmful consequences, such as liver damage from excessive drinking, depressive moods due to heavy substance use, drug-related deterioration in cognitive functions. It should be established that the consumer was actually aware of the nature and extent of the harmful consequences, or at least that this can be assumed.

 

 

Diagnostic features for F1X.2:

Persistent substance use despite evidence of clear harmful consequences, such as liver damage from excessive drinking, depressive moods due to heavy substance use, drug-related deterioration in cognitive functions. It should be established that the consumer was actually aware of the type and extent of the harmful consequences, or at least that it can be assumed.

A restricted behavior pattern in dealing with psychotropic substances was also described as a characteristic feature (e.g. the tendency to consume alcoholic beverages on workdays in the same way as on weekends, regardless of the usual social drinking behavior).

An essential characteristic of the addiction syndrome is current consumption or a strong desire for the psychotropic substance. The inner compulsion to consume substances is usually realized when an attempt is made to stop or control the consumption.

This diagnostic requirement excludes, for example, surgical patients who have received opiates for pain relief and who develop an opiate withdrawal syndrome when these drugs are discontinued, but who themselves have no desire to continue taking opiates.

The addiction syndrome can relate to a single substance (for example tobacco or diazepam), to a group of substances (such as opiates), or also to a broader spectrum of different substances (such as for those people who experience some kind of compulsion, regularly each to take only accessible means and develop the excruciating feelings, restlessness and / or physical withdrawal symptoms of abstinence).

The category "F19.X Mental and behavioral disorders due to multiple substance use and consumption of other psychotropic substances" is to be used when consuming two or more psychotropic substances if it cannot be decided which substance caused the disorder. This category should also be used if one or more of the substances consumed cannot be identified with certainty or is unknown, as many users often do not know exactly what they are taking themselves.

 

The following 5th digits serve to further subdivide the addiction syndrome:

0 currently abstinent

1 currently abstinent but in a protective environment

2 current participation in a medically supervised substitute drug
program (controlled dependency)

1 currently abstinent, but on treatment with aversive or inhibitory drugs (e.g. naloxone / disulfiram). This also includes treatments with anti-craving substances such as Campral.

4 current substance use (active dependence)

5 constant substance use

6 episodic substance use (e.g. dipsomania)

Since the ICD-10 does not specify a specific time reference for the coding of the 5th digit, the criteria of the DSM-IV for a partial remission are based on. Accordingly, the period of the last 4 weeks before diagnosis is chosen as the reference period.