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The Essential ICD-10 Guide: Coding Alcohol Intoxication in Dual Diagnosis [2025 Update]

Stanley Efrem

Mar 26, 2025

The ICD-10-CM coding system has transformed the documentation of alcohol intoxication and substance use disorders. It introduced specific codes like F10 for alcohol use disorders. This detailed classification system shows major improvements from its predecessor, especially when dealing with substance use disorders.

Knowing how to code severe alcohol use disorder ICD 10 cases requires a clear understanding of these classifications. The system now offers more precise diagnostic categories for substance abuse ICD 10 documentation and includes specific codes for alcohol abuse with intoxication. The classification system also helps medical professionals distinguish between different stages of acute alcohol intoxication and substance use disorders.

This piece explains everything in ICD-10 coding for alcohol-related disorders. It helps medical professionals direct the complexities of dual diagnosis documentation and maintain accurate clinical records.

The Structure of Alcohol-Related Codes in ICD-10

The F10 code family in ICD-10-CM offers a complete classification system to document alcohol-related disorders. These codes appear in Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders of ICD-10. The "F" points to the chapter while "10" marks alcohol-related conditions [1].

Navigating the F10 code family

The F10 code family uses a hierarchical structure with three main categories that show how severe alcohol use is:

F10.1: Alcohol abuse
F10.2: Alcohol dependence
F10.9: Alcohol use, unspecified

These categories are the foundations for more detailed coding. Note that F10 by itself won't work for reimbursement because it lacks specificity. You'll need to pick from the detailed subcategories under it.

On top of that, the F10 category comes with important "use additional code" notes. To name just one example, see alcohol intoxication ICD 10 coding - you should add the blood alcohol level using Y90.- when you have that data [3]. This shows how the system values complete documentation.

The F10 code family sits within a larger substance use coding framework (F10-F19). Each substance gets its own code series [1]. Opioid-related disorders use F11, cannabis uses F12, and cocaine uses F14.

Understanding the decimal system for specificity

ICD-10's alcohol coding decimal system follows a structured pattern. Each digit after the decimal point adds clinical details. The fourth character shows the clinical signs, and the fifth character adds more specific information [1].

Here's how to code alcohol use disorder severe ICD 10 cases:

Start with the base code (F10)
Pick the right category (.1, .2, or .9)
Add a fourth digit for clinical signs:
- .x0 = uncomplicated
- .x1 = in remission
- .x2 = with intoxication
- .x3 = with withdrawal
- .x4 = with mood disorder
- .x5 = with psychotic disorder
Add a fifth digit for maximum detail

Acute alcohol intoxication ICD 10 coding needs you to determine its connection to alcohol abuse (F10.12x), dependence (F10.22x), or unspecified use (F10.92x) [4]. The fifth digit then specifies:

0 = uncomplicated (F10.120, F10.220, F10.920)
1 = with delirium (F10.121, F10.221, F10.921)
9 = unspecified intoxication (F10.129, F10.229, F10.929)

The code F10.12x for alcohol abuse with intoxication ICD 10 shows that a patient has an alcohol use disorder and is currently under alcohol's influence. You would use F10.122, F10.222, or F10.922 for perceptual disturbances during intoxication, based on the underlying condition [4].

ICD-10-CM asks for substantially more detail than the previous coding system. Substance abuse ICD 10 coding must show if the patient is in remission, has withdrawal symptoms, or faces mood disorders or psychosis [4].

The system also covers associated physical effects. Alcohol-induced conditions need both the F10 code and the specific medical condition code. Alcoholic pancreatitis from alcohol dependence needs both K85.2 and F10.20 [6].

Substance Abuse ICD-10 Coding Fundamentals

Understanding substance abuse coding hierarchies in ICD-10-CM will give accurate clinical documentation and proper reimbursement. ICD-10-CM has a much larger and more detailed section devoted to substance use disorders than its predecessor. Clinicians need to become skilled at specific coding differences.

Distinguishing between use, abuse, and dependence

ICD-10-CM creates a clear hierarchy among substance use patterns based on clinical severity. Official ICD-10-CM guidelines state that clinicians should assign only one code when multiple patterns of substance use are documented for the same substance. The hierarchy follows this order:

Dependence - A cluster of behavioral, cognitive, and physiological phenomena that develops after repeated substance use. This shows a strong desire to take the drug, difficulties in controlling its use, persistence despite consequences, increased tolerance, and sometimes physical withdrawal.
Abuse - The harmful or hazardous use of psychoactive substances that causes psychological or physical harm but doesn't meet dependence criteria.
Use - Substance consumption not documented as abuse or dependence.

So, you should assign only the dependence code if both abuse and dependence appear in documentation. The same rule applies when use, abuse, and dependence all appear - assign only the dependence code.

Applying appropriate 4th and 5th characters

The 4th and 5th characters add vital clinical details after you identify the primary substance and use pattern:

Fourth Character Options:

x0: Uncomplicated
x1: In remission
x2: With intoxication
x3: With withdrawal
x4: With substance-induced mood disorder
x5: With substance-induced psychotic disorder

Fifth Character Examples (for intoxication):

x20: Uncomplicated intoxication
x21: Intoxication with delirium
x22: Intoxication with perceptual disturbance

Let's look at alcohol abuse with intoxication (F10.12-). The fifth character tells us if it's uncomplicated intoxication (F10.120), intoxication with delirium (F10.121), or intoxication with perceptual disturbance (F10.122).

Coding for remission states

Over the last several years, ICD-10-CM added new codes for substance use disorders in remission, including F10.91 for alcohol use in remission. The provider must document that the patient achieved remission based on their clinical judgment.

Codes with the fourth character "1" (like F10.11) represent mild substance use disorders (previously "abuse") in remission. Moderate or severe substance use disorders (previously "dependence") in remission use codes with the fourth character "2" (like F10.21).

Note that ICD-10-CM makes a difference between early and sustained remission, though both states share the same code. The documentation must clearly state "in remission" because ICD-10-CM has no code for "history of" substance use disorder.

Alcohol Abuse with Intoxication: Specific Coding Guidelines

Medical professionals must evaluate a patient's clinical presentation carefully to select the right alcohol intoxication ICD-10 code. The three main code options might look alike at first glance, but they mainly differ in their basic alcohol use pattern.

F10.129 vs. F10.229 vs. F10.929: Choosing correctly

These three codes show the same clinical demonstration (intoxication) but have different basic alcohol use patterns:

F10.129: Alcohol abuse with intoxication, unspecified - Medical staff use this code when patients show harmful or hazardous alcohol use without meeting dependence criteria
F10.229: Alcohol dependence with intoxication, unspecified - Documentation must support alcohol dependence (moderate to severe alcohol use disorder)
F10.929: Alcohol use, unspecified with intoxication, unspecified - This code applies to cases where doctors haven't clearly documented the alcohol use pattern

The basic alcohol use pattern should guide your code selection. Code only for dependence (F10.229) if both abuse and dependence appear in documentation. ICD-10 guidelines state that "acute drunkenness in alcoholism" needs F10.22 coding rather than F10.12.

Documenting perceptual disturbances

Patients experiencing hallucinations or other perceptual disturbances during alcohol intoxication need these codes:

F10.122: Alcohol abuse with intoxication with perceptual disturbance
F10.222: Alcohol dependence with intoxication with perceptual disturbance
F10.922: Alcohol use, unspecified with intoxication with perceptual disturbance

Medical records must explicitly document perceptual disturbances to support these codes. F10.232 (Alcohol dependence with withdrawal with perceptual disturbance) relates to withdrawal, not acute intoxication.

Coding for intoxication delirium

Serious complications from intoxication delirium require specific codes:

F10.121: Alcohol abuse with intoxication delirium
F10.221: Alcohol dependence with intoxication delirium
F10.921: Alcohol use, unspecified with intoxication delirium

Providers must document both intoxication and delirium from alcohol consumption to use these codes. Delirium indicates a more severe clinical presentation than regular intoxication, with changes in cognition, attention, and awareness.

Blood alcohol level (Y90.-) can be added as a supplementary code when available. "Alcoholic ketoacidosis" and "chronic pancreatitis due to acute alcohol intoxication" may appear with these main codes.

Note that ICD-10 makes a clear difference between intoxication with delirium (F10.x21) and withdrawal with delirium (F10.x31). These codes serve distinct purposes in coding practice.

Coding Severe Alcohol Use Disorder in ICD-10

Coding severe alcohol use disorder correctly requires careful attention to clinical presentation and documentation requirements. ICD-10-CM classifies severe alcohol use disorder under code F10.20 (Alcohol dependence, uncomplicated), which became effective in the 2025 edition on October 1, 2024 [7].

Required clinical documentation

Documentation of severe alcohol use disorder must cover several core elements:

The specific substance (alcohol)
Severity level (explicitly documented as "severe")
Associated symptoms (maladaptive behaviors)
Any complications (intoxication, delirium, mood disorders)
Current remission status, if applicable
Treatment approaches [8]

Medical records should establish the diagnostic criteria pattern clearly. Providers must document that patients show a problematic pattern of alcohol use that causes significant impairment or distress, beyond just noting "alcohol dependence" or "alcoholism" [8].

Physiological dependence indicators

DSM-5 criteria states that severe alcohol use disorder needs six or more symptoms within a 12-month period [8]. This is different from moderate alcohol use disorder that needs 4-5 symptoms, and mild alcohol use disorder that needs 2-3 symptoms [9].

Key diagnostic indicators include:

Too much time to get, use, or recover from alcohol effects
Failed attempts to control use
Important activities given up for alcohol use
Continued use despite physical/psychological problems
Tolerance (needing increased amounts)
Withdrawal symptoms [8]

Withdrawal phenomena and coding implications

The documentation of withdrawal with severe alcohol use disorder uses code F10.23- with appropriate fifth characters [10]:

F10.230 - Withdrawal, uncomplicated
F10.231 - Withdrawal delirium ("delirium tremens")
F10.232 - Withdrawal with perceptual disturbance
F10.239 - Withdrawal, unspecified [11]

Withdrawal coding is different from intoxication coding (F10.22-). To name just one example, "alcohol withdrawal syndrome" uses code F10.239 [11], while "alcohol withdrawal delirium" needs code F10.231 [12].

Code F10.21 (Alcohol dependence, in remission) applies to both early and sustained remission states [13]. Note that mild substance use disorders in remission use substance abuse in remission code (F10.11), while moderate or severe disorders in remission need the dependence in remission code (F10.21) [6].

Dual Diagnosis Coding Strategies

Medical professionals must document dual diagnoses with careful attention to substance use disorders and co-occurring psychiatric conditions. The right coding makes a dramatic difference in reimbursement and shows the true complexity of patient care.

Sequencing rules for multiple diagnoses

Medical coders need specific rules when documenting alcohol intoxication (ICD-10) among other psychiatric conditions. The code sequence should start with the root cause, and then list its effects [14]. You'll find this "code first" and "use additional code" pattern throughout the ICD-10 tabular section.

The main reason for treatment should determine the principal diagnosis in dual diagnosis patients [15]. A patient who needs alcohol withdrawal management but also has depression would get the F10.239 code first. The medical team should still list chronic conditions that affect decision-making as secondary diagnoses [14].

Z-codes for psychosocial factors

Medical records use Z-codes (Z55-Z65) to capture key social factors that often come with substance abuse (ICD-10) cases [16]. These codes show:

Z59 codes for housing/economic circumstances (homelessness, poverty)
Z60 codes for social environment (isolation, acculturation difficulties)
Z63 codes for primary support group problems (family disruption, dysfunctional relationships)

Z-codes help create better clinical documentation but healthcare providers rarely use them, despite their value in telling the patient's complete story [17]. To name just one example, see how using Z63.0 with F10.20 can show relationship conflicts that make alcohol use disorder severe (ICD-10) worse.

Linking substance use to psychiatric manifestations

Documentation should clearly show connections between substance abuse (ICD-10) and its psychiatric effects. Doctors should use F10.24, F10.14, or F10.94 for alcohol-induced mood disorders, based on the pattern of use [1].

Note that acute alcohol intoxication (ICD-10) can trigger temporary psychiatric symptoms different from independent disorders. Healthcare providers should document whether psychiatric symptoms started before substance use or happened because of intoxication [15].

Quality measurement and proper reimbursement ended up depending on complete coding—this matters even more as payers start giving complexity scores to patients in value-based care plans [14].

2025 Updates to Alcohol and Substance Use Disorder Codes

Clinical documentation specialists must implement the most important changes to alcohol and substance use disorder coding from the October 2024 ICD-10 updates.

Recent guideline changes

The ICD-10-CM coding guidelines for 2025 strengthen the hierarchical structure for substance use disorders. We arranged the hierarchy rule to ensure dependence takes precedence over abuse, which then takes precedence over use [4]. After that, coders should assign only one code when multiple patterns appear in the documentation for the same substance.

The guidelines now explain that substance use disorders in remission (F10-F19) need careful clinical judgment. Doctors should classify milder cases as "substance abuse in remission," while severe cases need "substance in remission" coding classification.

New code additions and revisions

The Centers for Medicare & Medicaid Services (CMS) announced 50 new ICD-10-PCS procedure codes that start April 1, 2025. CDC reported no new ICD-10-CM diagnosis codes for this update cycle [18]. The April 2025 diagnosis code update files fix revisions and typographical errors. Coders should use these for patient encounters from April 1 through September 30, 2025.

The 2025 edition of alcohol intoxication ICD-10 codes started working October 1, 2024, including F10.10 (alcohol use disorder, mild) [19]. These codes match with Diagnostic Related Groups including MS-DRG v42.0 for substance-related conditions.

Documentation requirement updates

The new substance abuse ICD-10 coding requires doctors to connect substance-related conditions with associated medical diagnoses [4]. Coders should assign both substance-related and medical condition codes when a patient shows both conditions, such as alcoholic pancreatitis with alcohol dependence.

Blood alcohol levels should now use Y90 codes for acute alcohol intoxication ICD-10 documentation [link_2], even when other clinicians document them instead of the primary provider [4]. This change expands the acceptable documentation sources.

The "unspecified" diagnoses for psychoactive substance use must now show a clear connection with a medical condition or substance-related disorder. This change removes vague coding practices that reduced clinical specificity.

Conclusion

Medical professionals need to pay close attention to detail for accurate ICD-10 coding of alcohol intoxication and dual diagnosis. A full picture of the F10 code family structure enables you to pick the right codes based on severity, symptoms and related conditions.

Note that signs of dependence override abuse classifications in cases with multiple patterns. Your records need to show clear diagnostic criteria, physical indicators and any related psychiatric conditions. It also helps to include Y90 codes for blood alcohol levels if they are accessible to more people.

The 2025 updates call for more detailed documentation, especially when you have substance use disorders in remission. These changes show how healthcare continues to prioritize accurate clinical reporting and proper payment.

Becoming skilled at these coding guidelines ensures precise clinical documentation, fair reimbursement and improved patient outcomes. The system might appear complex, but doing this hierarchical structure and meeting documentation requirements will make your coding process smoother and enhance reporting precision.

FAQs

What is the ICD-10 code for alcohol dependence with intoxication?

The ICD-10 code for alcohol dependence with intoxication is F10.229. This code falls under the F10 family, which represents alcohol-related disorders in the ICD-10 classification system.

How do I choose between F10.129, F10.229, and F10.929 when coding for alcohol intoxication?

The choice depends on the underlying alcohol use pattern. F10.129 is for alcohol abuse with intoxication, F10.229 for alcohol dependence with intoxication, and F10.929 for unspecified alcohol use with intoxication. Always code for dependence if both abuse and dependence are documented.

What documentation is required for coding severe alcohol use disorder?

Documentation should include the specific substance (alcohol), severity level (explicitly stated as "severe"), associated symptoms, any complications, current remission status if applicable, and treatment approaches. The presence of six or more symptoms within a 12-month period is required for a severe classification.

How should dual diagnoses be coded in ICD-10?

When coding dual diagnoses, the underlying etiology should generally be sequenced first, followed by its manifestations. For instance, if a patient is admitted primarily for alcohol withdrawal management but also has depression, the alcohol-related code (e.g., F10.239) would appear first, followed by the depression code.

Are there any significant changes to alcohol and substance use disorder codes in the 2025 ICD-10 update?

While there are no new ICD-10-CM diagnosis codes for alcohol and substance use disorders in the 2025 update, the guidelines reinforce the hierarchical structure for substance use disorders. The update also emphasizes greater specificity in documentation, particularly for substance use disorders in remission.