Changes for Emergency Medicine in ICD-10 Diagnosis Coding for 2019 Unlike CPT code changes that occur on the calendar year, ICD-10 code changes are updated and effective in October. Emergency department relevant codes added, deleted, or revised include the areas of mental and behavioral presentations, cerebral infarction, and appendicitis. In keeping with the times, there are two new codes related to cannabis use:

• F12.23, cannabis dependence with withdrawal
• F12.93, cannabis use with withdrawal

Code F12.23, cannabis dependence with withdrawal, was created to distinguish cannabis withdrawal syndrome in a patient with cannabis dependence. Code F12.93, cannabis use, unspecified with withdrawal, was created for cases of physiological withdrawal from cannabis occurring in a person who is using cannabis regularly in contexts that are not specifically defined as cannabis dependence.

Example: A 26-year-old male presents to the emergency department with tingling in his hands and feet. He has a history of generalized anxiety disorder and has been smoking cannabis on a daily basis for the last 10 months to help with his anxiety. The patient abruptly stopped smoking cannabis three days ago and, in addition to the tingling, also complains of a cough. Physical exam was reassuring and a chest X-ray was negative. Various approaches to anxiety treatment, including counseling and pharmacotherapy, were discussed. The patient will follow up with his primary care physician and understands reasons to return to the emergency department. The final diagnoses for the visit includes cannabis use with withdrawal F12.93.

Dr. Granovsky is the president of Logix Health, an emergency department coding and billing company, and serves as the course director of ACEP’s coding and reimbursement courses.

Mr. McKenzie is reimbursement director for ACEP.