ICD-10 Training Camp: A Snapshot of Mental Health Conditions and ICD-10-CM Diagnosis Codes

Nancy Maguire, ACS, PCS, FCS, HCS-D, CRT September 30th, 2011

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 ICD-10 Chapter V: Mental and behavioral disorders is part of the International Classification of Diseases produced by the World Health Organization (WHO). Mental health professionals have long relied on a coding system known as DSM-IV. In the DSM-IV system Psychiatric Diagnoses are categorized by the Diagnostic and Statistical Manual of Mental Disorders, 4th.edition.  The manual is published by the American Psychiatric Association and covers all mental health disorders for children and adults. It also lists known causes of these disorders, statistics in terms of gender, age at onset, and prognosis as well as some research concerning the optimal treatment approaches.

The coding system used in the DSM-IV is designed to correspond with the codes used in the ICD-10 classification, although not all codes may match at all times because the two publications are not revised synchronously. ICD-10 and DSM-IV diagnoses are comparable for the most relevant points.  The ICD-10-CM diagnosis classification is used to code patient diagnosis with date of service October 1, 2013 and after.

Each chapter of ICD-10 begins with a listing of related code ranges (blocks).  Chapter 5 ICD-10 Blocks include:

  • F01-F09 Mental disorders due to known physiological conditions;
  • F10-F19 Mental and behavioral disorders due to psychoactive substance use;
  • F20-F29 Schizophrenia, schizotypal and delusional, and other non-mood psychotic disorders;
  • F30-F39 Mood [affective] disorders;
  • F40-F48 Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders;
  • F50-F59 Behavioral syndromes associated with physiological disturbances and physical factors;
  • F60-F69 Disorders of adult personality and behavior; F70-F79 Mental retardation;
  • F80-F89 Pervasive and specific developmental disorders;
  • F90-F98 Behavioral and emotional disorders with onset usually occurring in childhood and adolescence; and,
  • F99 Unspecified mental disorder. 

As you can see, each block begins with the same alpha letter “F”.  There is no requirement for a 7th character extensor in chapter 5.

A number of codes have been significantly expanded in ICD-10

A number of codes have been significantly expanded in ICD-10 (e.g., injuries, diabetes, substance abuse, postoperative complications).  F10.182 – “Alcohol abuse with alcohol-induced sleep disorder” is an example of this expansion.  The block that covers schizophrenia, schizotypal states and delusional disorders (F20-F29) has been expanded by the introduction of new categories such as undifferentiated schizophrenia (F20.3), schizoaffective disorder, depressive type (F25.1), and schizotypal disorder (F21).

Alcohol dependence is defined in the I-10 classification in a way that is similar to the DSM. Category F10.1- F10.99 describes alcohol abuse and dependence.  These categories require 5 or 6 characters to complete the code.  There is no referencing back for a 5th digit (ICD-9 requirement), each code is complete.  Example: code F10.221 “Alcohol dependence with intoxication delirium.”

Bipolar disorder, category F31, includes manic-depressive illness, manic-depressive psychosis, and manic-depressive reaction.  Example: code F31.62 states “Bipolar disorder, current episode mixed, moderate.”  Clinical documentation will require greater detail than physicians have been using for the past 30 years.  Training of both coders and providers will take time and should be factored into the ICD-10 transition budget for years 2012-2013.

October 1, 2013, is the deadline for implementation and use of ICD-10-CM and ICD-10-PCS.  For diagnosis coding purposes, the ICD-10 diagnosis codes will be used to assign codes to documented conditions for a specific patient encounter, in any place of service.  If you are assigning ICD-9 codes now, you will be assigning ICD-10 diagnosis codes on October 1, 2013.  CPT and HCPCS codes will not change for physician billing.  It is recommended that clinicians should follow the general rule of recording as many diagnoses as are necessary to cover the clinical picture.

You may be assigning codes from other chapters in ICD-10-CM

It is very likely you will be assigning codes from other chapters in ICD-10-CM based on medical record documentation.  Chapter 19 contains codes for injuries, poisoning, and adverse effects. Codes from chapter 19 (T40, T51) for example, would be used in conjunction with the F10-F19 codes if a patient has an acute alcohol or drug poisoning, even if the patient is dependent on alcohol or drugs.  Another example involves a code from the nervous system (G30.9).  If the patient has documented dementia due to an underlying condition, the underlying condition (eg, alzheimer’s), is first-listed code (G30.9). The dementia would be second-listed (F02.81).

Chapter 5, Block F01-F09, comprises a range of mental disorders grouped together on the basis of their having in common a demonstrable etiology in cerebral disease, brain injury, or other insult leading to cerebral dysfunction. The dysfunction may be primary, as in diseases, injuries, and insults that affect the brain directly and selectively; or secondary, as in systemic diseases and disorders that attack the brain only as one of the multiple organs or systems of the body that are involved. Example, code F06.1, “Catatonic disorder due to known physiological condition”.

The lesson to be learned is to acquire the knowledge and understanding of ICD-10 codes used by the practice. This is accomplished by taking a proactive approach and keeping an open mind.  A lesson learned is an experience or outcome of a particular course of action.  A positive outcome follows a positive course of study.

Nancy Maguire discusses coding mental health claims with ICD-10Nancy Maguire, ACS, PCS, FCS, HCS-D, CRT, author of The Nancy Maguire GPS to ICD-10-CM Planning and Implementation Guide, is a nationally-renowned procedural and diagnostic coding instructor, bootcamp trainer, and workshop leader. She has spent more than 30 years as a hands-on coder and has authored countless coding articles and presentations. In her expansive career, she has transitioned from nursing, to coding, to practice management, auditing and consulting. Nancy served as Director of Coding and Reimbursement at UTMB in Galveston Texas for four years. She served the first two terms as president of AAPC in the early 1990s.

Hear Nancy speak in two complimentary archived webinars on ICD-10 presented by Kareo medical billing software: How to Prepare for ICD-10/5010 to Reduce F41.1 (Anxiety Reaction) or Preparing for ICD-10-CM: The Nitty-Gritty of Diagnosis Coding

 

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