MRA Thought of the Day – Pattern of Use: Watch Your Fifth Digits

Cathie Wilde, RHIA, CCS - Director, Coding Services Medical Coding Leave a Comment


Cathie Wilde, RHIA, CCS, Vice President of Coding Services Cathie Wilde, RHIA, CCS, Vice President of Coding Services

A 56 year old male presents to the emergency room with alcohol withdrawal after discontinuing alcohol 24 hours prior to presentation. He is placed on CIWA protocol and admitted to the hospital. The attending physician notes in the history that the patient has a diagnosis of alcoholism for over twenty-five years drinking at least one six pack of beer on a daily basis.

What fifth digit would be assigned for the alcoholism code?

Here are my thoughts…

Prior Coding Clinic advice (2 Q 1991, p. 11) stated a patient with daily intake of alcohol indicated a continuous pattern of use – fifth digit of “1”

However, this advice was updated in a more recent Coding Clinic (1Q 2010, p. 20-21). This Coding Clinic states the fifth digit descriptions in the prior publication were provided as examples only and that the provider must specifically state the pattern of use, continuous, episodic or in remission. If the documentation is not specific to pattern of use, the fifth digit of “0” for unspecified must be assigned.

The Coding Clinic goes further to clarify that the designation of the patient’s pattern of use in alcohol and drug abuse/dependence must come from the provider who is legally responsible for diagnosing the patient. Therefore, mental health counselor assessment documentation of pattern of use cannot be used in assigning the fifth digit.

In our case scenario above, the coder must assign 303.90 as the final diagnosis.

What are your thoughts?

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