Coding based on current severity: Note for lCD-10-CM codes: If a tobacco withdrawal or tobacco-induced sleep disorder is also present, do not use the codes below for tobacco use disorder. Instead, the comorbid tobacco use disorder is indicated in the 4th character of the tobacco-induced disorder code (see the coding note for tobacco withdrawal or tobacco- induced sleep disorder). For example, if there is comorbid tobacco-induced sleep disorder and tobacco use disorder, only the tobacco—induced sleep disorder code is given, with the 4th char- acter indicating whether the comorbid tobacco use disorder is moderate or severe: F17.208 for moderate or severe tobacco use disorder with tobacco-induced sleep disorder. It is not per— missible to code a comorbid mild tobacco use disorder with a tobacco-induced sleep disorder.
Specify current severity: 305.1 (272.0) Mild: Presence of 2—3 symptoms.
305.1 (F17.200) Moderate: Presence of 4—5 symptoms.
305.1 (F17.200) Severe: Presence of 6 or more symptoms.
"On maintenance therapy" applies as a further specifier to individuals being maintained on other tobacco cessation medication (e.g., bupropion, varenicline) and as a further specifier of remission if the individual is both in remission and on maintenance therapy. ”In a controlled environment” applies as a further specifier of remission if the individual is both in remission and in a controlled environment (i.e., in early remission in a controlled environment or in sus- tained remission in a controlled environment). Examples of these environments are closely su- pervised and substance-free jails, therapeutic communities, and locked hospital units.
Tobacco use disorder is common among individuals who use cigarettes and smokeless to- bacco daily and is uncommon among individuals who do not use tobacco daily or who use nicotine medications. Tolerance to tobacco is exemplified by the disappearance of nausea and dizziness after repeated intake and with a more intense effect of tobacco the first time it is used during the day. Cessation of tobacco use can produce a well-defined withdrawal syndrome. Many individuals with tobacco use disorder use tobacco to relieve or to avoid withdrawal symptoms (e.g., after being in a situation where use is restricted). Many indi- tinue to smoke. The large majority report craving when they do not smoke for several hours.
Spending excessive time using tobacco can be exemplified by chain-smoking (i.e., smok- ing one cigarette after another with no time between cigarettes). Because tobacco sources are readily and legally available, and because nicotine intoxication is very rare, spending a great deal of time attempting to procure tobacco or recovering from its effects is uncom- mon. Giving up important social, occupational, or recreational activities can occur when an individual forgoes an activity because it occurs in tobacco use—restricted areas. Use of tobacco rarely results in failure to fulfill major role obligations (e.g., interference with work, interference with home obligations), but persistent social or interpersonal problems (e.g., having arguments with others about tobacco use, avoiding social situations because of others’ disapproval of tobacco use) or use that is physically hazardous (e.g., smoking in bed, smoking around ﬂammable chemicals) occur at an intermediate prevalence. Although these criteria are less often endorsed by tobacco users, if endorsed, they can indicate a more severe disorder.