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History of Smoking ICD 10: Essential Guide for Medical Coders [2025 Update]

Stanley Efrem

Apr 1, 2025

The World Health Organization reports more than 40 percent of smokers across the globe lose their lives to lung diseases. These include cancer, chronic respiratory diseases, and tuberculosis. Tobacco use stands as the leading preventable cause of death in the United States. Healthcare providers now see accurate documentation of smoking history ICD 10 codes as a vital part of patient care.

The ICD-10 code Z87.891 helps medical professionals document a patient's personal history of nicotine dependence. This documentation allows doctors to spot potential health risks early. The stakes are high since smoking causes more deaths each year than the combined toll of alcohol use, motor vehicle accidents, illegal drug use, and firearm-related injuries.

This piece guides you through the essentials of coding smoking history. You'll learn the simple classifications and get up to speed with the latest 2025 updates needed for accurate medical documentation.

Understanding ICD-10 Codes for Smoking History

Medical documentation and treatment planning rely heavily on accurate coding of a patient's smoking status. The ICD-10-CM coding system provides specific codes to document smoking history and current tobacco use.

Z87.891: Personal history of nicotine dependence

Z87.891 serves as a billable diagnostic code that specifically indicates a personal history of nicotine dependence [1]. The code became effective in the 2025 edition of ICD-10-CM on October 1, 2024 [1]. Medical coders should use this code for patients who were former smokers but no longer have nicotine dependence.

Z87.891 works well for reimbursement purposes, yet remains classified as an unacceptable principal diagnosis [2]. The code doesn't point to a current problem but describes circumstances affecting the patient's health status.

On top of that, it has synonyms like "ex-cigarette smoker," "ex-pipe smoker," and "ex-tobacco chewer" [2]. A type 1 excludes note states that Z87.891 should never appear with current nicotine dependence codes (F17.2) [1].

F17 codes: Current nicotine dependence

F17 codes document active nicotine dependence in a hierarchical structure. The F17.2 category has various subcodes that specify tobacco product type and clinical state:

F17.20 - Nicotine dependence, unspecified
F17.21 - Nicotine dependence, cigarettes
F17.22 - Nicotine dependence, chewing tobacco
F17.29 - Nicotine dependence, other tobacco product [4]

Additional digits provide more detail by showing complications, remission status, or withdrawal symptoms [5]. F17.210 shows nicotine dependence from cigarettes without complications [6].

Z72.0: Tobacco use without dependence

Z72.0 represents tobacco use without dependence [4]. This billable code fits patients who use tobacco but don't meet clinical criteria for nicotine dependence [7]. Common clinical terms linked to this code include "cigarette smoker," "cigar smoker," and "chews tobacco" [8].

The code Z72.0 can't appear with history of tobacco dependence (Z87.891) or current nicotine dependence codes (F17.2) [7].

Difference between history and current use codes

The difference between these codes is vital for accurate documentation:

Duration and status - Z87.891 shows past dependence that's resolved, while F17 codes show current dependence [9].
Mutual exclusivity - ICD-10 guidelines don't allow Z codes with F17 codes. Only one code should document a patient's tobacco use [5].
Clinical significance - Z87.891 suggests the patient's past nicotine dependence might affect current health issues.
Dependence factor - Z72.0 documents tobacco use without clinical dependence, while F17 codes clearly show dependence [5].

Medical coders must review documentation carefully to pick the right code based on the patient's current status rather than historical information.

Proper Documentation Requirements for Smoking History

Complete documentation of smoking history forms the foundation for accurate ICD-10 coding and patient care that works. Research shows that in 60% of patients, medical records included smoking status. The numbers were higher by a lot for COPD (86%) and sleep apnea (83%) patients [10].

Everything in document

Your smoking history documentation should include these key elements:

Smoking status (current, former, or never smoker)
Number of packs smoked per day
Years smoked (to calculate pack-years)
Type of tobacco product used
Quit date (for former smokers)

The documentation should include complications or related conditions that support proper code selection. Studies reveal only 28% of current or former smokers had enough documentation to determine if they qualified for lung cancer screening [11].

Specifying tobacco product types

Simple notes like "current smoker" aren't enough. You need to identify the specific tobacco product. A better approach would be "currently smokes a few cigarettes weekly when socializing" instead of vague statements [12]. This level of detail becomes especially important when you have e-cigarettes and vaping devices that need different coding approaches.

Documenting quit date and duration

The quit date is a vital piece of information for former smokers. Studies show that only 59% of former smokers had their quit dates in their records [11]. This detail helps determine eligibility for preventive services like lung cancer screening and affects code selection between Z87.891 and F17 codes.

EHR documentation best practices

Make use of structured data fields in your electronic health record system instead of free-text fields. Team members struggle to find information buried in free-text notes [5]. Here's how you can improve documentation:

Use checkboxes and pick lists to minimize data entry
Program EHR systems to automatically populate applicable text in after-visit summaries
Design workflows where tobacco cessation interventions are documented systematically
Update smoking status at each encounter

Good documentation supports accurate ICD-10 coding and leads to better clinical decisions and quality of care.

Common Coding Scenarios and Solutions

Real-world coding scenarios will help you better understand history of smoking ICD 10 codes. Let's get into some common situations you'll face in medical coding practice.

Former smoker who quit

The most appropriate code for patients who stopped smoking in the last 12 months is F17.211 - Nicotine dependence, cigarettes, in remission rather than a history code. This difference matters because the remission status acknowledges the patient's achievement while showing their continued relapse risk. The "in remission" designation applies whatever time the patient quit. One coding authority puts it simply: "If they smoked, they smoked; time doesn't change that fact" [13].

Long-term former smoker

The right code for long-term former smokers who quit more than a year ago is Z87.891 - Personal history of nicotine dependence. This code has synonyms like "ex-smoker for more than 1 year" and "former smoker quit more than 1 year ago" [1]. Keep in mind that Z87.891 can't be used with current nicotine dependence codes (F17.2) due to Type 1 Exclusion rules.

Patient with occasional tobacco use

Z72.0 - Tobacco use NOS is the correct code if you have patients who smoke socially or occasionally without dependence. This applies to "social smokers" rather than those who smoked heavily from addiction [14]. Z72.0 should never appear with history codes (Z87.891) or current dependence codes (F17.2).

Coding for secondhand smoke exposure

Two distinct codes exist to document secondhand smoke exposure:

Z77.22 - Contact with and (suspected) exposure to environmental tobacco smoke applies to passive smoking in non-occupational settings like home environments [15].
Z57.31 - Occupational exposure to environmental tobacco smoke specifically covers workplace exposure [15].

These codes are mutually exclusive - you can't use Z77.22 with Z57.31 [5]. Both codes can supplement primary diagnosis codes to show environmental factors affecting your patient's health.

Special Coding Considerations for 2025

The 2025 ICD-10-CM code updates introduce major changes to smoking documentation with 252 new codes, 36 deletions, and 13 revisions that take effect October 1, 2024 [16]. Medical coders must pay immediate attention to these modifications for accurate documentation and proper reimbursement.

Updates to ICD-10 tobacco codes

The 2025 update adds more specificity to existing condition codes [17]. Chapter 5's (Mental and Behavioral Disorders) additions enhance the documentation of nicotine dependence through type and severity codes [17]. Healthcare initiatives now favor detailed clinical documentation to improve payment, data transfer, and transparency [17].

Coding for e-cigarettes and vaping products

Coders must carefully document electronic nicotine delivery systems (ENDS) in 2025. The code F17.29- (Nicotine dependence, other tobacco products) should be assigned for vaping-related nicotine dependence [18]. Non-combustible tobacco products fall under this code category [18].

Specific condition codes apply to vaping-associated lung injuries (EVALI):

J68.0 for chemical pneumonitis
J69.1 for lipoid pneumonia
J84.89 for other specified interstitial pulmonary disease [19]

Code J68.9 (Unspecified respiratory condition due to chemicals) should be used when no specific condition appears in documentation [19].

Coding for smoking during pregnancy

O99.33- codes document pregnancy-related tobacco use with mandatory trimester details:

O99.330 - Smoking complicating pregnancy, unspecified trimester
O99.332 - Smoking complicating pregnancy, second trimester
O99.333 - Smoking complicating pregnancy, third trimester [20]

These codes need an additional code from category F17 to show the nicotine dependence type [21]. This combination captures both pregnancy's effects and the specific tobacco product used.

Reimbursement implications

Medicare now demands proper tobacco cessation coding for service payments in 2025. CMS guidelines extend coverage for cessation counseling to all nicotine delivery systems, beyond traditional tobacco products [22]. The Medicare Fee Schedule has codes 99406 and 99407 for cessation counseling with national payment amounts of $15.57 and $28.72 [23]. Medicare beneficiaries can access these services without out-of-pocket costs [23].

Conclusion

Proper ICD-10 codes for smoking history documentation is vital for patient care and reimbursement. Z87.891 is the main code to document past nicotine dependence. F17 codes capture current tobacco use patterns effectively.

Medical coders need to choose these codes carefully based on detailed patient records. A complete documentation should list smoking status, pack-years, tobacco products used, and quit dates for former smokers. The 2025 updates will bring major changes that focus on e-cigarette use and pregnancy-related tobacco consumption.

Code selection affects both documentation and reimbursement rates while improving patient care quality. Medicare now offers expanded coverage for cessation counseling across all nicotine delivery systems. This makes accurate coding more significant for healthcare providers.

Healthcare teams must understand these differences and stay updated with coding changes to maintain compliance and enhance patient care outcomes. Precise documentation helps monitor health better and creates more effective treatment plans for patients with smoking history.

FAQs

What is the ICD-10 code for a history of smoking?

The ICD-10 code Z87.891 is used to indicate a personal history of nicotine dependence. This code is appropriate for patients who have quit smoking and are no longer dependent on nicotine.

How should current smokers be coded in ICD-10?

Current smokers should be coded using the F17 series of codes. For example, F17.210 indicates nicotine dependence from cigarettes without complications. The specific code used depends on the type of tobacco product and any associated complications.

Is there a difference between coding for tobacco use and nicotine dependence?

Yes, there is a distinction. Z72.0 is used for tobacco use without dependence, while F17 codes indicate nicotine dependence. It's important to accurately document the patient's status to select the appropriate code.

How should e-cigarette or vaping product use be coded?

For vaping-related nicotine dependence, coders should use F17.29- (Nicotine dependence, other tobacco products). This code category applies to all non-combustible tobacco products, including e-cigarettes and vaping devices.

Are there special considerations for coding smoking during pregnancy?

Yes, pregnancy-related tobacco use employs O99.33- codes with mandatory trimester specification. These codes require an additional code from category F17 to identify the type of nicotine dependence, accurately capturing both the pregnancy impact and specific tobacco product used.