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Alcohol has significant impact on the mind, reducing the ability to exercise normal judgment and think rationally. Although considered a depressant, when consumed in small to moderate quantities, alcohol may produce stimulant effects. Many people find that initially, alcohol may help them to “loosen up” in social situations; over time, however, with heavier and/or problematic use, depressant effects of alcohol can become more prominent. Many people with AUD also have other psychiatric conditions, such as other substance use disorders, mood disorders, anxiety disorders, schizophrenia, and/or post-traumatic stress disorder. The International Statistical Classification of Diseases (ICD) diagnosis codes support the medical necessity for performing a service. The physician must clearly indicate the reason(s) for all the services rendered to ensure the selection of the most specific code.
The reliability studies and the cross-national comparisons spurred the development of more specific classification systems for diagnosing alcoholism and other psychiatric disorders, especially for research purposes. The Feighner criteria for alcoholism had a relatively complex structure. A long list of symptoms was divided into four categories, and at least one symptom from three of these four categories was required for a definite alcoholism diagnosis. The categories can be seen as indicators of (1) physiological aspects of heavy drinking, (2) loss of control over drinking, (3) antisocial behaviors connected to drinking, and (4) guilt about drinking or impaired interpersonal relationships. Over the last several years, considerable evidence has accumulated on the reliability and validity of modern definitions of alcohol dependence and abuse/harmful use.
Alcohol abuse, uncomplicated
Nearly 88,000 people die from alcohol-related causes annually, making it the third leading preventable cause of death in the United States. Alcohol use also contributes to over 200 diseases and injury-related health conditions, most notably AUD, liver cirrhosis, cancers, and injuries. If an individual is a binge drinker and/or a heavy drinker, it is possible they may have an AUD. However, AUD is possible even without https://www.excel-medical.com/5-tips-to-consider-when-choosing-a-sober-living-house/ drinking above these limits, as people differ in how sensitive they are to alcohol’s effects and what constitutes problematic use of alcohol. Counseling Risk Factor Reduction and Behavioral Change Intervention codes are not reported when the physician counsels an individual patient with symptoms or an established illness. In this case, a problem-oriented E/M service from CPT code section 99201–99215 is reported.
Outside the United States, the ICD–10 is the system more likely to be used (e.g., Conigrave et al. 2002; Lange et al. 2002; Shaikh et al. 2001; Wutzke et al. 2002). This article provides historical background on the development of the current classification systems; describes similarities and differences between DSM–III–R, DSM–IV, and ICD–10; and reviews the evidence for the reliability and validity of the alcohol dependence and abuse diagnoses. For coding alcohol use, abuse and dependence coders must have to follow separate coding guidelines. Now, in ICD 10 CM codebook there are separate entries for alcohol abuse, alcohol dependence, and new entries for alcohol use disorders. The assessment method in most research on alcohol use disorders consists of a structured diagnostic interview that assesses diagnostic criteria with a specified, structured procedure. In any particular study, the reliability of a diagnosis cannot be completely separated from the reliability of the diagnostic interview.
Recent changes to ICD-10-CM codes relevant to psychologists
The evidence comes from studies conducted in clinical samples, general population samples, and samples of participants and their relatives in genetics studies, and not only from U.S. samples but also from samples assessed in many countries around the world. The evidence is very consistent regarding the classification of alcohol dependence (Hasin et al. 2003). This diagnosis, as represented in DSM–III–R, DSM–IV, and ICD–10, has consistently been shown to be reliable and valid. Based on the evidence, investigators can use this category in their research with a high degree of confidence.
- A kappa of 1.0 indicates that all pairs of raters agreed perfectly on their diagnostic assessments.
- The risk of alcohol dependence begins at low levels of drinking and increases directly with both the volume of alcohol consumed and a pattern of drinking larger amounts on an occasion, to the point of intoxication, which is sometimes called binge drinking.
- To standardize assessment of the RDC criteria, a semistructured diagnostic interview, the Schedule for Affective Disorders and Schizophrenia (SADS) (Endicott and Spitzer 1978) was designed.
- An important one is within Chapter V, which covers mental health and substance disorders.
Decisions on revisions of codes for ICD-11 in the coming months will be influenced by a variety of inputs and considerations. The suggestions by Touquet and Harris for enhancing the ICD system are valuable input for this process, pointing to the importance of codes that will be used in the emergency-department environment both for capturing alcohol’s involvement and to point to the necessary therapeutic response. A reliability coefficient summarizes the agreement level of all pairs of assessments.
Coding guide for Alcohol use, Abuse and Dependence in ICD 10
Many state Medicaid programs require that services be submitted using HCPCS Level II codes. The key objective for the provider is to determine the degree to which alcohol use is impacting the patient’s life and health. The DSM-5 criteria are the gold standard for identifying the patient’s degree of impairment. The COVID-19 Pandemic has significantly changed American life, including the use of alcoholic beverages.
These results are similar to the results from the reliability studies, suggesting that it is not inherently invalid criteria that are the source of validity problems for abuse/harmful use but rather the residual structure of alcohol abuse/harmful use relative to dependence. Respondents diagnosed with alcohol dependence were likely to remain chronic, though few of the subjects were in treatment. In contrast, respondents diagnosed with abuse were less likely to exhibit symptoms of their disorder at followup and unlikely to have become dependent. Taken as a group, these studies support the validity of the alcohol dependence category as well as the distinction between alcohol dependence and abuse. Almost without exception, the studies indicated excellent reliability for current DSM–IV alcohol dependence or ICD–10 alcohol dependence (i.e., kappas above 70 [for an explanation of kappas, see the sidebar on p. 7]). The reliability of lifetime dependence diagnoses also was good to excellent across these studies.
During the recent COVID-19 pandemic, Mr. H has seen the decline of his small private business. He admits to gradually increasing his drinking during the lockdown due to financial stress. The CAGE questionnaire, the name of which is an acronym of its four questions, is a widely used method of screening for alcohol dependence. An additional code, for avoidant/restrictive food intake disorder, has been moved from “Other specified eating disorder” to “Other eating disorder,” classifying it alongside Binge eating disorder (F50.81). Additional changes were made to diagnostic codes for pain management and neurology. Slightly more than half of Americans (56%) report drinking alcohol in the past month, while about a quarter (25%) report binge drinking in the past month.
