According to the World Health Organization (WHO), more than 40 percent of smokers globally die from lung diseases, such as cancer, chronic respiratory diseases and tuberculosis. Tobacco use is the largest preventable cause of death and disease in the United States. Every year, May 31 is observed as World No Tobacco Day to highlight the health risks associated with tobacco use and encourage government and stakeholders to take steps to reduce smoking and the use of other tobacco products. The tagline of this year’s event is “Don’t let tobacco take your breath away”. Primary care physicians need to make use of opportunities to provide smoking cessation advice, a potentially lifesaving intervention. Knowledge of codes and payers’ tobacco cessation requirements is necessary to submit claims and get paid. Partnering with an experienced family practice medical billing company is the best option for practitioners to get paid for cessation services using the proper service and diagnosis codes.

Symptomatic and Asymptomatic Patients

  • Patients are classified as symptomatic or asymptomatic (www.lung.org). Symptomatic patients are those who use tobacco and
    • Have been diagnosed with a disease or an adverse health effect that has been found by the U.S. Surgeon General to be linked to tobacco use; or
    • Take a therapeutic agent for which the metabolism or dosing is affected by tobacco use, based on information approved by the U.S. Food and Drug Administration (FDA)

Asymptomatic patients are those who use tobacco but do not have symptoms of tobacco-related disease.

Diagnosis Coding

When diagnosing for tobacco use, there are two coding options, depending on whether there is dependence on tobacco or not:

  • ICD-10 F17 codes – if the patient is dependent on tobacco
  • Z codes – if there is NOT dependence on tobacco. Z codes cannot be combined with an F code.

The Z codes cannot be combined with an F17 code. Only one code should be used to report the patient’s tobacco use. For example, if the patient uses and is dependent, only the code for the dependence should be assigned. The sixth digit in ICD-10 code describes the patient’s dependence as follows:

  • 0 Uncomplicated
  • 1 In remission
  • 3 With withdrawal
  • 8 With other nicotine-induced disorders
  • 9 With unspecified nicotine-induced disorders

ICD-10 Codes for Nicotine Dependence

  • F17.20- Nicotine dependence, unspecified
  • F17.200 Nicotine dependence, unspecified, uncomplicated
  • F17.201 Nicotine dependence, unspecified, in remission
  • F17.203 Nicotine dependence, unspecified, with withdrawal
  • F17.208 Nicotine dependence, unspecified, with other nicotine-induced disorders
  • F17.209 Nicotine dependence, unspecified, with unspecified nicotine-induced disorders
  • F17.21- Nicotine dependence, cigarettes
  • F17.210 Nicotine dependence, cigarettes, uncomplicated
  • F17.211 Nicotine dependence, cigarettes, in remission
  • F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders
  • F17.219 Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders
  • F17.22- Nicotine dependence, chewing tobacco
  • F17.220 Nicotine dependence chewing tobacco uncomplicated
  • F17.223 Nicotine dependence chewing tobacco in remission
  • F17.228 Nicotine dependence chewing tobacco with other nicotine-induced disorders
  • F17.229 Nicotine dependence chewing tobacco with unspecified nicotine-induced disorders
  • F17.29- Nicotine dependence, other tobacco product
  • F17.290 Nicotine dependence, other tobacco product uncomplicated
  • F17.291 Nicotine dependence, other tobacco product in remission
  • F17.293 Nicotine dependence, other tobacco product with withdrawal
  • F17.298 Nicotine dependence, other tobacco product with other nicotine induced disorders
  • F17.299 Nicotine dependence, other tobacco product with unspecified nicotine induced disorders

Additional Options for Describing the Patient’s Tobacco Status

  • Z77.22 Exposure to environmental tobacco smoke
  • P98.81 Exposure to tobacco smoke in the perinatal period
  • O99.33- Tobacco use during pregnancy
  • T65.2 Toxic effect of tobacco and nicotine

Z Codes (if there is NOT Dependence on Tobacco)

The American Lung Association provides the following guidance on the use of the Z codes:

  • Z57.31 Occupational exposure to environmental tobacco smoke (may not be used with Z77.22 exposure to environmental smoke)
  • Z77.22 Contact with and suspected exposure to environmental smoke (may not be used with a F17.2 tobacco dependence or Z72 tobacco use code)
  • Z71.6 Counseling and Medical Advice – tobacco abuse counseling
  • Z72.0 Problems related to lifestyle and tobacco use not otherwise specified
  • Z87.891 Personal history of nicotine dependence (may not be used with F17.2 current nicotine dependence code)
  • Z13.89 Encounter for screening for other disorder. Use for tobacco use screening

Documentation Tips

Claims should be supported by proper documentation. Here are some tips to document tobacco use:

  • The documentation should specify the type of product used, frequency of tobacco use and any relevant modifying factors to support ICD-10 code selection (the use of unspecified codes should be limited).
  • For non-tobacco users, documentation may include “non-smoker – no exposure” or “patient denies tobacco exposure”.
  • Providers should use structured data fields within their electronic health record (EHR), where possible, for recording tobacco use and/or dependence. (Free-text information in narrative notes is not searchable, and is more difficult to find or view by other members of the care team and medical billing and coding service provider (www.tobaccofreeny.org).
  • The following items should be documented in the medical record (www.lung.org):
    • Patient’s willingness to attempt to quit
    • What was discussed during counseling
    • Amount of time spent counseling
    • Tobacco use
    • Advice to quit and impact of smoking provided to patient
    • Methods and skills suggested to support cessation
    • Medication management
    • Setting a quit date with the patient
    • Follow-up arranged
    • Resources made available to the patient

While a physician coding service provider can help with ICD 10 code assignment, all payers require that the physician documents medical necessity and specifics of services provided.