Nicotine dependence, chewing tobacco, with withdrawal

This code signifies a patient's physiological and psychological dependence on nicotine, specifically from the use of chewing tobacco, accompanied by the presence of withdrawal symptoms. These symptoms typically manifest when the patient reduces or ceases their chewing tobacco use.

Apply this code when documentation clearly indicates a diagnosis of nicotine dependence due to chewing tobacco and explicitly states the patient is experiencing withdrawal symptoms. This is appropriate for patients presenting with irritability, anxiety, difficulty concentrating, or other classic nicotine withdrawal signs related to their chewing tobacco cessation efforts.

• Ensure documentation specifies "chewing tobacco" as the nicotine source, not other forms like cigarettes or cigars.
• Confirm the presence of withdrawal symptoms; if only dependence is documented without withdrawal, a different code is required.
• Consider sequencing this code as a secondary diagnosis if the primary reason for the encounter is treatment of a related medical condition exacerbated by nicotine dependence.