TRYING TIMES CALL FOR A REFRESHER ON CHAPTER 5 CODING

Cathie Wilde, RHIA, CCS - Director, Coding Services Education Leave a Comment

TRYING TIMES CALL FOR A REFRESHER ON CHAPTER 5 CODING

With several major events including the pandemic and its domino effects (e.g., social isolation, job loss), racial strife, natural disasters, and senseless shootings the past eighteen months or so has taken its toll on humankind in the form of increased mental health distress and drug abuse. The increase in mental health challenges patients are facing provides a good opportunity for review of Chapter 5 of the ICD-10-CM classification system, Mental, Behavioral and Neurodevelopmental disorders.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) published by the American Psychiatric Association (APA) is a nomenclature used by psychiatrists primarily for criteria to diagnose mental disorders.[1] ICD-10-CM mental disorder codes are similar but do not always match DSM-V. While DSM-5 is used to diagnose and treat mental disorders, Chapter 5 (F01-F99) of ICD-10-CM is predominantly for insurance purposes and monitoring of morbidity and mortality statistics.

One of the most prevalent areas for mental disorder coding is the coding for Mood (affective) disorders (F30-F39). Affective disorders include bipolar disorders and major depression disorder (MDD). These two disorders exclude one another; it is important to reference the Excludes 1 notes. The disorders are classified according to severity – unspecified, mild, moderate, and severe. In addition, there are codes to designate with and without psychotic features as well as in partial or full remission.

Bipolar affective disorder (BPAD) is a mood disorder that is characterized by periods of depression with periods of abnormally elevated mood that can last from days to weeks. Mania is the term used when the elevated mood is severe or associated with psychosis and hypomania when the elation is less severe. In addition to bipolar disorder, BPAD is also referred to as manic depression and includes cyclothymia and dysthymic disorders. Cyclothymia is a type of mood disorder characterized by fast and repeated changes from hypomanic and depressed moods. Dysthymia is a persistent type of mild to moderate depression without psychosis. BPAD are classified into four categories in ICD-10-CM:

F30.-      Manic episode

F31.-      Bipolar disorder

F34.-      Persistent mood (affective) disorders

F39.-      Unspecified mood (affective) disorder

 

MDD if often referred to simply as depression and is characterized by prolonged periods (at least two weeks) of pervasive low mood causing emotional, mental, and physical exhaustion. MDD is classified into two categories in ICD-10-CM:

F32.-      Major depressive disorder, single episode

F33.-      Major depressive disorder, recurrent

 

Mental disorders due to known physiological conditions (F01-F09) includes dementia conditions and delirium due to known physiological conditions. Both have the instructional note to “Code first the underlying physiological condition”. Some of those underlying conditions include Alzheimer’s, Parkinson’s, Lewy body, and hypertensive cerebrovascular disease. The dementia code categories, F01.- vascular dementia and F02.- dementia in other diseases classified elsewhere make a distinction between with and without behavioral disturbance. Behavioral disturbances include aggression, combativeness and wandering off. If wandering off is present, an additional code of Z91.83 would be added per use additional code instructional note.

Schizophrenia (F20.-) is a severe mental illness characterized by continuous or relapsing episodes of psychosis with symptoms including hallucinations, delusions, disorganized thinking, apathy, bizarre behavior and decreased social interactions. Types of schizophrenia include paranoid (F20.0-), disorganized (F20.1-), catatonic (F20.2-), undifferentiated (F20.3-) and residual (F20.5-).

Schizoaffective disorder (F25.-) is characterized by abnormal thought processes and an unstable mood with the patient having symptoms of both schizophrenia and a mood disorder. The classification provides separate codes for the mood disorder type as bipolar (F25.0) or depressive (F25.1).

Take note of excludes 1 notes under categories F20.- and F25.-. Both codes exclude mood (affective) disorders with psychotic symptoms (F30.2, F31.2, F31.5, F31.64, F32.3, F33.3).

Nonpsychotic mental disorders (F40-F48) include anxiety disorders, reactions to stress, dissociative and conversion disorders, and somatoform disorders. The more common disorders are generalized anxiety disorder (F41.1), obsessive-compulsive disorders (F42.-) and post-traumatic stress disorder (PTSD) (F43.1-). PTSD develops because of a traumatic event such as sexual assault or domestic violence with resulting symptoms that may include flashbacks of the event, nightmares, mental or physical distress to trauma-related cues and difficulty falling and staying asleep. These symptoms last more than a month and significantly impair functioning. Adjustment disorders (F43.2-) involve a psychological response to a stressor but the stressor is less intense than those associated with PTSD or an acute stress disorder.

Dissociative and conversion disorders are found in category F44.-. In dissociative disorders, there is a disconnection and a lack of continuity between thoughts, memory, awareness, identity, perceptions, actions, and surroundings. As a result, patients escape reality in ways that are involuntary and unhealthy with poor functioning. Patients may present with a neurological symptom that is not consistent with an organic cause but rather determined to be the result of a psychological trigger. An example is dissociative amnesia; there is no organic cause for the amnesia, but some form of psychological stress precipitates the amnesia.

Eating, sleeping and sexual disorders are located under categories F50-F59, Behavioral syndromes associated with physiological disturbances and physical factors. The disorders include anorexia nervosa, bulimia nervosa, sleepwalking, excessive sexual drive, and postpartum depression. Disorders of adult personality and behavior are found within categories F60-F69. Borderline personality disorders, impulse disorders, gender identity disorders, and Munchausen’s syndrome are in this section.

Suicidal ideation (R45.851) and the use of restraints (Z78.1) can often be present when treating mental health disorders. Adding these codes when appropriate potentially provides an indicator of the severity of the patient’s condition.

 

Resources

[1] https://www.psychiatry.org/psychiatrists/practice/dsm, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683251/

 

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