What are the ICD‑10‑CM codes for current tobacco use, nicotine dependence, current cannabis use, cannabis dependence, and past cannabis use?

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ICD-10-CM Codes for Tobacco and Cannabis Use

The specific ICD-10-CM codes you need are: Z72.0 for current tobacco use, F17.2xx for nicotine dependence (with specific subcodes based on product and remission status), Z72.51 for current cannabis use, F12.2x for cannabis dependence (with subcodes for remission status), and Z86.43 for past cannabis use.

Tobacco-Related ICD-10-CM Codes

Current Tobacco Use (Non-Dependent)

  • Z72.0 documents current tobacco use without meeting criteria for nicotine dependence 1
  • This code applies when the patient smokes but does not exhibit dependence symptoms 2

Nicotine Dependence

  • F17.2xx is the primary code series for nicotine dependence, with specific subcodes based on tobacco product type 1
  • The fourth character specifies the tobacco product:
    • F17.20x = cigarettes
    • F17.21x = chewing tobacco
    • F17.22x = other tobacco products 1
  • The fifth character indicates remission status:
    • 0 = uncomplicated (current use with dependence)
    • 1 = in early remission (3-12 months abstinent)
    • 3 = in sustained remission (>12 months abstinent) 1

Documentation Requirements

  • Assess nicotine dependence using validated tools like the Fagerström Test for Nicotine Dependence 2
  • Document time to first cigarette after waking, as this guides both ICD-10 coding and treatment intensity 1
  • Quantify exposure in pack-years (1 pack-year = 20 cigarettes/day for 1 year) 2

Cannabis-Related ICD-10-CM Codes

Current Cannabis Use (Non-Dependent)

  • Z72.51 documents current cannabis use without meeting dependence criteria 2
  • This applies to recreational or medical cannabis users who do not exhibit cannabis use disorder 2

Cannabis Dependence

  • F12.2x is the code series for cannabis dependence (cannabis use disorder) 2
  • The third character specifies remission status:
    • F12.20 = uncomplicated (current use with dependence)
    • F12.21 = in early remission (3-12 months abstinent)
    • F12.23 = in sustained remission (>12 months abstinent) 2

Past Cannabis Use

  • Z86.43 documents personal history of cannabis use when the patient is no longer using 2
  • This code is appropriate for former users who have been abstinent for >1 year 2

Clinical Assessment for Coding Accuracy

Determining Dependence vs. Use

  • Apply DSM-5 criteria to diagnose cannabis use disorder: mild (2-3 criteria), moderate (4-5 criteria), or severe (≥6 criteria) 2
  • Document physiological dependence indicators including tolerance and withdrawal symptoms (insomnia, irritability, anxiety) emerging within 24-72 hours of cessation 2
  • For tobacco, assess time to first use after waking: <30 minutes indicates higher dependence severity 1

Frequency Classification

  • Current user: use within the past 30 days 1
  • Former/recent user: no use for >30 days but <1 year 1
  • Past user: no use for >1 year 2

Common Coding Pitfalls

Co-Use Considerations

  • When patients use both tobacco and cannabis, assign separate codes for each substance 3, 4
  • Cannabis and tobacco co-use is associated with higher nicotine dependence rates, so assess both substances independently 4
  • Mixing tobacco with cannabis (coadministration) increases nicotine exposure and dependence risk, warranting F17.2xx coding even in patients who primarily identify as cannabis users 3

Documentation Timing

  • Smoking status should be documented as a vital sign at every visit 2
  • The timing of assessment (≤3 minutes, 3-10 minutes, or >10 minutes) relates to ICD-10 coding and reimbursement for cessation counseling 1
  • Reassess and update codes at each encounter, as status may change with treatment 1

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Clinical Documentation of Tobacco and Cannabis Use

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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