ICD-10 Code for Suspension of Illicit Drug Use
The appropriate ICD-10 code for a patient with a history of substance use disorder who is suspending illicit drug use is Z86.4 (Personal history of psychoactive substance abuse), or more specifically, the substance-specific remission codes within the F10-F19 series (e.g., F11.21 for opioid dependence in remission).
Understanding the ICD-10 Coding Framework
The ICD-10 classification system distinguishes between active substance use disorders and remission states. For patients who have suspended illicit drug use, the coding approach depends on whether they previously met criteria for dependence or abuse, and their current clinical status 1.
Active vs. Historical Coding
For patients currently in remission from a diagnosed substance use disorder, use the substance-specific codes with remission specifiers (e.g., F11.21 for opioid dependence in sustained remission, F14.21 for cocaine dependence in sustained remission) 2
For patients with a remote history of substance use without current disorder, use Z86.4 (Personal history of psychoactive substance abuse) 2
The distinction between "early remission" and "sustained remission" in DSM-IV/ICD-10 terminology affects the specific fifth digit used, though both indicate suspension of use 2
Substance-Specific Code Selection
When coding for suspension of specific illicit drugs, select from the F11-F19 series with appropriate remission modifiers 1:
- F11.21: Opioid dependence, in remission (for heroin or non-prescribed opioid analgesics)
- F14.21: Cocaine dependence, in remission
- F15.21: Other stimulant dependence, in remission (for methamphetamine)
- F12.21: Cannabis dependence, in remission
- F19.21: Other psychoactive substance dependence, in remission (for polysubstance use)
Important Coding Considerations
Specificity matters for surveillance and treatment planning: Using substance-specific codes rather than generic "drug use" codes provides better data for tracking treatment outcomes and resource allocation 3, 4
Remission codes have high specificity (85-96%) but low sensitivity (36-50%) when validated against self-report, meaning they accurately identify patients when documented but miss many cases 4, 5
Documentation quality directly impacts code accuracy: ICD-10 codes for substance use are most sensitive when documented during outpatient visits (34-44% sensitivity) compared to emergency department visits (5-9% sensitivity) 4
Critical Pitfalls to Avoid
Do not use active use disorder codes (F11.20, F14.20, etc.) for patients who have suspended use, as this misrepresents their current clinical status and may affect insurance coverage and treatment access 2
Avoid using only Z86.4 for patients with recent or ongoing treatment needs, as this historical code does not capture the clinical complexity of early remission or the need for continued substance use disorder treatment 1
Do not assume code absence means no substance use: The low sensitivity of ICD-10 substance codes means many patients with substance use history will not have it documented, particularly in emergency settings 4, 5
Clinical Context for Code Selection
The choice between remission codes and historical codes should reflect the patient's engagement with treatment and risk of relapse 1:
Use remission codes (F11.21, etc.) when: The patient is actively engaged in treatment, receiving medication-assisted therapy, or requires ongoing monitoring for relapse prevention 6, 7
Use Z86.4 when: The patient has a remote history without current treatment needs or active risk factors for relapse 2
Consider polysubstance code F19.21 when multiple substances were used, as this is common among persons who use drugs illicitly and affects treatment planning 1