Volume 4, Issue 8, August 2017 Last Revised: April 2018

Risk Adjustment Coding Academy – Coding Focus

Sedative, Hypnotic or Anxiolytic Use Disorder

 Continued use despite hypnotic or anxiolytic related psychosis awareness that the substance under HCC 54 and diagnoses for causes worsening physical or sedative, hypnotic or anxiolytic psychological problems dependence under HCC 55. For risk  Developing withdrawal upon adjustment purposes, sedative, hypnotic stopping use of the substance or anxiolytic abuse, uncomplicated (F13.10) and unspecified sedative, Complications and Treatment hypnotic or anxiolytic use, uncomplicated (F13.90) are not included Many of the drugs found in this in the model. classification are considered generally Sedative, Hypnotic & Anxiolytic safe for short term use, when taken as

Sedatives, hypnotics and anxiolytics refer prescribed. However, as the body Sedative, Hypnotic or Anxiolytic Use to a class of drugs that are used primarily becomes accustomed to the effects of Disorders to relieve anxiety, provide aid with sleep the drug, tolerance can develop and (HCC 54/55) disorders or to produce a calming effect larger doses are needed to achieve the on the central nervous system. They may same effect. Continued use may result in F13.1_* ‐ abuse also be used to treat seizures or as dependence or withdrawal if the drug is F13.2_* ‐ dependence anesthesia for surgical procedures. abruptly reduced or stopped. F13.9_* ‐ use

They include drugs like benzodiazepines, Although very unpleasant, the Subcategories include: SSRIs (selective serotonin reuptake withdrawal symptoms from *._0 – uncomplicated inhibitors), tricyclic antidepressants and benzodiazepines are rarely life *._1 – in remission buspirone. Barbiturates also fall into this threatening. Conversely, withdrawal *._2 – with intoxicaon∞ category, though they are not widely from barbiturates can have life‐ *._3 – with withdrawal used today due to their limited window threatening complications 3 . Therefore, *._4 – with induced mood disorder of effectiveness before toxicity occurs1. patients should consult with a physician *._5 – psychotic disorders∞ Substance Use Disorders when discontinuing the use of sedatives. *._6 – persisting amnestic disorder The Diagnostic and Statistical Manual of Coding Guidance *._7 – persisting dementia Mental Disorders, Fifth Edition (DSM‐5), *._8 – other induced disorders∞ Diagnosis codes for sedative, hypnotic or *._9 – unspecified induced disorder now refers to substance use disorders, anxiolytic related disorders are located in rather than using the previous chapter five of ICD‐10‐CM, under code ∞sixth character is required terminology of substance abuse and category F13 and include subcategories substance dependence. Substance use which indicate use, abuse and disorders are further defined as mild, dependence. Additional fifth and sixth 2 Resources: moderate or severe . The level of character specifiers are used to indicate severity depends upon the number of specific complications. Coding guidance 1 criteria that are met, which include: Drugs.com. (n.d.) Anxiolytics, sedatives, and is included in sections 5b1 and 5b2, hypnotics. Retrieved July 20, 2017 from drugs.com 2  Using larger amounts for longer which provide instructions for SAMHSA (n.d.) Substance Use Disorders. designating remission status and provide Retrieved July 20, 2017 from samhsa.gov than intended 3 National Institute on Drug Abuse. (2016). Misuse  Having cravings and urges to the hierarchy for proper code of Prescription Drugs. Retrieved July 20, 2017 from use the substance assignment based on the documented drugabuse.gov 4 4  Continuing to use the substance pattern of use respectively . Schmidt, A., Kenney, A., Krawzik, K., & Willard, P. (2016). ICD‐10‐CM expert for physicians 2017: The even when it causes social or The CMS‐HCC Risk Adjustment Model complete official code set. Place of publication not relationship problems (V23) lists diagnoses for sedative, identified: Optum360°

Coverage provided by Amerigroup, Inc. Reference the ICD-10-CM codebook, CMS-HCC Risk Adjustment Model V23, and AHA Coding Clinic for complete code sets and official coding guidance. It is not guaranteed that the information supplied is without defect. Any redistribution or other use is strictly forbidden.

Y0114_17_32322_I_08/09/2017