The clinician should use the code that applies to the class of substances but record the name of the specific substance. For example, the clinician should record 292.0 (F13.239) seco- barbital withdrawal (rather than sedative, hypnotic, or anxiolytic withdrawal) or 292.89 (F15.129) methamphetamine intoxication (rather than stimulant intoxication). Note that the appropriate ICD-lO-CM diagnostic code for intoxication depends on whether there is a comorbid substance use disorder. In this case, the F15.129 code for methamphetamine in- dicates the presence of a comorbid mild methamphetamine use disorder. If there had been no comorbid methamphetamine use disorder, the diagnostic code would have been
F15.929. ICD-lO-CM coding rules require that all withdrawal codes imply a comorbid moderate to severe substance use disorder for that substance. In the above case, the code for secobarbital withdrawal (F13.239) indicates the comorbid presence of a moderate to se- vere secobarbital use disorder. See the coding note for the substance-specific intoxication and withdrawal syndromes for the actual coding options.
For substances that do not fit into any of the classes (e.g., anabolic steroids), the appropriate code for "other substance intoxication" should be used and the specific substance indicated (e.g., 292.89 [F19.929] anabolic steroid intoxication). If the substance taken by the individual is unknown, the code for the class ”other (or unknown)” should be used (e.g., 292.89 [F19.929] unknown substance intoxication). If there are symptoms or problems associated with a partic- ular substance but criteria are not met for any of the substance-specific disorders, the unspec- ified category can be used (e.g., 292.9 [F1299] unspecified cannabis-related disorder).
As noted above, the substance—related codes in ICDlOCM combine the substance use dis- order aspect of the clinical picture and the substance-induced aspect into a single combined code. Thus, if both heroin withdrawal and moderate heroin use disorder are present, the single code F1123 is given to cover both presentations. In ICD-9-CM, separate diagnostic codes (292.0 and 304.00) are given to indicate withdrawal and a moderate heroin use disorder, re- spectively. See the individual substance—specific sections for additional coding information.
The substance/medication-induced mental disorders are potentially severe, usually tem- porary, but sometimes persisting central nervous system (CNS) syndromes that develop in the context of the effects of substances of abuse, medications, or several toxins. They are distinguished from the substance use disorders, in which a cluster of cognitive, behav- ioral, and physiological symptoms contribute to the continued use of a substance despite significant substance-related problems. The substance / medication-induced mental disor- ders may be induced by the 10 classes of substances that produce substance use disorders, or by a great variety of other medications used in medical treatment. Each substance- induced mental disorder is described in the relevant chapter (e.g., ”Depressive Disorders,” ”Neurocognitive Disorders”), and therefore, only a brief description is offered here. All substance/medication-induced disorders share common characteristics. It is important to recognize these common features to aid in the detection of these disorders. These features are described as follows:
A. The disorder represents a clinically significant symptomatic presentation of a relevant mental disorder.
B. There is evidence from the history, physical examination, or laboratory findings of both of the following: 1. The disorder developed during or within 1 month of a substance intoxication or 2. The involved substance/medication is capable of producing the mental disorder.