Mental, Behavioral and Neurodevelopmental Disorders (F01-F99) ICD-10-CM

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AGPCARE-0078-19 63318MUPENABS 09/15/16 Chapter 5: “Mental, Behavioral and „„ Category of mood disorders, code range F30-F39, Neurodevelopmental Disorders (F01-F99)” includes conditions such as manic episode, bipolar Currently mental health professionals use two disorder, major depressive disorder and persistent classification systems for coding mental disorders: the mood disorders. International Classification of Diseases (ICD) and the „„ If insomnia is due to a mental health Diagnostic and Statistical Manual of Mental Disorders illness/behavioral condition, code F51.05 should (DSM). The DSM-5® offers diagnostic codes solely for be assigned followed by a code reporting the exact mental disorders while the ICD-10-CM has codes for both mental disorder. physical and mental disorders. „„ When hearing loss causes a delay in a patient’s development of speech and language, code F80.4, „„ Specificity, detail and expansion of some codes: The classification improves with more subchapters, the type of hearing loss should be identified as an categories, subcategories and more codes that additional code. provide greater clinical detail. Most notable are „„ If delirium is due to an identified physiological other isolated or specific phobias and alcohol and condition, the underlying condition should be coded substance abuse. first followed by code F05, delirium due to known physiological condition. „„ The codes in this chapter are to be assigned with provider documentation of a mental or behavioral disorder based on their clinical judgment not just Depression When diagnosing depression, according to DSM-5, five founded upon symptoms, signs and abnormal or more of the symptoms listed below must be present clinical laboratory findings. during the same two-week time period that denotes „ Combination codes for mental and behavioral „ changes in functioning. At least one symptom is either a health: Combination codes have been generated for depressed mood or loss of interest. drug and alcohol use and associated conditions such as withdrawal, sleep disorders or psychosis. A code Recurrence Symptoms for blood alcohol level (Y90.-) can be assigned as a • Depressed mood as indicated in the supplementary code when documentation supports Most of subjective report or in remarks made its use. the day by others „ „ Certain diseases have been reclassified to reflect Nearly • Markedly diminished interest in Changes in names up-to-date medical knowledge: every day pleasure in all/almost all, activities and definitions of disorders have been made to reflect more current clinical terminology and • Significant weight loss when not dieting to regulate the terms used to diagnose mental, or weight gain or changes in appetite behavioral and substance use disorders. • Insomnia or hypersomnia „„ Pain disorders linked to psychological factors • Psychomotor agitation or retardation (F45.4-): Code F45.41 should be assigned for Nearly • Fatigue or loss of energy somatoform pain disorder, indicating psychological every day • Diminished ability to think or pain that is not supported by another medical concentrate, or indecisiveness condition and code F45.42 designated for genuine • Feelings of worthlessness, excessive or medical pain with related psychological factors. inappropriate guilt When using F45.42, report the associated acute • Recurrent thoughts of death or chronic pain (G89.-) as well. Note that pain not otherwise specified (NOS) is reported with R52, and Major depressive disorder (MDD) Documentation of MDD should specify the severity, if this code should not be used with category F45.4-. known, such as: „„ Sequencing of the intellectual disability codes „ Episode: single versus recurrent (F70 - F79): When coding in ICD-10-CM, the „ Severity: mild, moderate or severe connected physical or developmental disorder „„ With or without psychotic features should be coded first followed by the intellectual „„ Remission status: partial or full disability code. „„ Recurrent depressive disorder: Schizophrenia Repeated episodes of depression without any history Codes are in category F20 and are broken down of independent episodes of mood variations or mania. by subtype: There has been at least one previous episode lasting at „„ Paranoid schizophrenia (F20.0) least two weeks and separated by the present event for „„ Disorganized schizophrenia (F20.1) two months minimum. No hypomanic or manic episodes „„ Catatonic schizophrenia (F20.2) in the past. (e.g., MDD, recurrent, severe with psychotic „„ Undifferentiated schizophrenia (F20.3) features [33.3]). „„ Residual schizophrenia (F20.5) „„ Schizophreniform disorder (F20.81) Severe episodes include: „„ Other schizophrenia (F20.89) MDD, recurrent, severe without psychotic features (F33.2) and major depressive disorder, recurrent, severe Example: with psychotic features (F33.3). Patient who suffers from paranoid schizophrenia comes „„ The appropriate codes for in remission are assigned in for a check-up. He is doing well on medication and only on the basis of documentation by the provider continuing with his psychotherapy but has started to (as defined in the ICD-10-CM Official Guidelines for gain weight. Labs were ordered to check his possible side Coding and Reporting I.C.5.b.1). For a classification effects of medication, and weight control was discussed. of n in remission, the patient has to have two or more depressive episodes in the past but be free ICD-10-CM: paranoid schizophrenia (F20.0); abnormal from depressive symptoms for several months. This weight gain (R63.5) category can still be used if the patient is receiving Other conditions treatment to reduce the risk of further episodes. „„ Vascular dementia: two common types include „„ Major depressive disorder, single episode, in full vascular dementia without behavioral disturbance remission (F32.5); major depressive disorder, (F01.50) and vascular dementia with behavioral recurrent, in partial remission (F33.41) disturbance (F01.51) Example: „„ Eating disorders: such as anorexia nervosa, Patient presents with symptoms of depression for the restricting type (F50.01); anorexia nervosa, binge past year including feelings of sadness, loss of energy, eating/purging type (F50.02); bulimia nervosa difficulty sleeping, etc. No significant medical issues. (F50.2) Her symptoms began when her relationship of eight „„ Pervasive developmental disorders: such as autism years ended. Patient scored a 24 on the Beck Depression (F84.0) and Aspergers’s syndrome (F84.5) Inventory (BDI) and was diagnosed with moderate MDD. Bipolar disorder ICD-10-CM: major depressive disorder, single episode, Patient suffers dramatic mood swings from mania moderate (F32.1) to depression. In ICD-10, it is classified by the following parameters: Persistent mood disorder „„ Type: type I or type II „„ Cyclothymic disorder (F34.0) „„ Current episode: hypomanic, manic, depressed, „„ Dysthymic disorder (F34.1) mixed Severity: mild, moderate or severe Certain anxiety and stress-related disorders „„ „„ Social phobia (F40.1-) „„ With or without psychotic features „„ Specific (isolated) phobias (example: animal type „„ Remission status: partial or full [F40.21-]) Example: „„ Panic disorder (F41.0) Patient recently began feeling depressed and comes „„ Generalized anxiety disorder (GAD) (F41.1) in for a check-up on her bipolar disorder. She admits „„ Obsessive-compulsive disorder (OCD) (F42.-) to being noncompliant with taking her antipsychotic „„ Post-traumatic stress disorder (PTSD) (F43.1-) medication. Importance of taking medication as indicated „„ Adjustment disorder (F43.2-) discussed. Medication will be increased for a short period, and the patient will return in one week. ICD-10-CM: bipolar disorder (F31.9), under dosing of „„ Nicotine dependence that is further classified by unspecified antipsychotics and neuroleptics, initial tobacco type (e.g., cigarettes and chewing tobacco) encounter (T43.506A) and patient’s intentional and whether there is an associated complication under dosing of medication regimen for other reason (e.g., withdrawal or nicotine induced disorder) (Z91.128) (F17.- ) Substance use, abuse and dependence Drug use, abuse and dependence In ICD-10, the classification of terms substance use, Drug use, abuse and dependence categories are further abuse and dependence are not interchangeable; they broken down identifying: are separate conditions. According to the Official Coding „„ With intoxication (e.g., uncomplicated, delirium, Guidelines, when the provider documentation refers to perceptual disturbances) use, abuse and dependence of the same substance (e.g., „„ With induced psychotic disorder (e.g., delusions, alcohol or opioid), only one code should be assigned hallucinations, other) based on the following hierarchy: „„ With other induced disorder (e.g., anxiety disorder, Code only When documented sexual dysfunction, sleep disorder, other disorder, unspecified) Abuse Use and abuse Abuse and dependence Examples: Dependence Use and dependence Patient presents to the office with personal history of alcohol dependence. Use, abuse and dependence ICD-10-CM: alcohol dependence, in remission (F10.21) The ICD-10-CM classification system does not provide separate “history” codes for alcohol and drug Patient presents with an anxiety disorder due to dependence. A patient with a personal history of drug cocaine abuse. or alcohol dependence is coded as “in remission.” ICD-10-CM: cocaine abuse with cocaine-induced anxiety disorder (F14.180) Alcohol use, abuse and dependence „„ Alcohol abuse (F10.0-) References „„ Alcohol dependence (F10.2-) Mueller, K. ICD-10-CM: Are You Ready?. (2014): asge.org „„ Alcohol use, unspecified (F10.9-) American Academy of Professional Coders. ICD-10 Resource: Coding for Major Depressive Disorder (2013) retrieved from: aapc.com Alcohol abuse and dependence codes no longer identify World Health Organization. International Classification of Diseases: continuous or episodic use. who.int Those codes are further broken down into the following: IMedX. ICD-10-CM Chapter Specific Coding Guidelines: Chapter 5, Mental, Behavioral and Neurodevelopmental Disorders (July 2015): „„ Uncomplicated imedx.com With intoxication, withdrawal, alcohol-induced „„ Universal Class. ICD-10-CM Coding Guidelines-Mental Disorders psychotic disorder and persisting amnestic and Behavioral Disorders (Chapter 5) and Diseases of the Nervous disorder; alcohol-induced persisting dementia; System (Chapter 6): universalclass.com other alcohol-induced disorder; and unspecified Pulse Systems, Inc. Top 20 Mental/Behavioral Treatment ICD-9 to alcohol induced disorder. ICD-10 codes (2013): pulseinc.com Anita Schmidt, K.K, & P.W (2016). ICD-10-CM Expert for Physicians. Nicotine use and dependence Optum 360 Codes related to nicotine in ICD-10-CM include: „„ Tobacco use (Z72.0) „„ Personal history of nicotine dependence (Z87.891) „„ Exposure to environmental tobacco smoke (Z77.22) „„ Occupational exposure to environmental tobacco smoke (Z57.31) „„ Exposure to tobacco smoke in the perinatal period (P96.81)