Diagnosis Coding for Mental Health in ICD-10-CM

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By Holly Cassano, CPC

In my article earlier this week, I illustrated some of the statistics on people who suffer from a mental illness/disorder in this country, as details emerged in the news that the perpetrator of the Newtown school shooting suffered from a form of Asperger’s syndrome, to bring further awareness to the seemingly epidemic level that these conditions currently represent.

Asperger’s syndrome, which is classified in ICD-10-CM as a schizoid personality disorder, is represented by ICD-10-CM, F60.1 – Schizoid personality disorder/Asperger’s syndrome. With more than 26% of the population in the U.S. over the age of 18 affected by a form of mental disorder, about 6% can be categorized with a major illness, such as Asperger’s.

One of the changes for ICD-10-CM is the developers wrote specific guidelines to allow for further specificity for mental disorders. Currently, in ICD-9-CM, there are basically none to instruct providers and coders for better reporting, which can make coding and billing for these services a reimbursement nightmare for many practices, as most insurers have specific guidelines for reporting.

ICD-10-CM will allow for more effective documentation of these illnesses/disorders, which will improve reimbursement back to the practice. As a reminder, providers and billing/coding professionals should adhere to the golden rules of proper medical record documentation:

  • Complete and legible
  • Documentation of each encounter
  • Reason for encounter
  • Examination findings
  • Diagnostic test results
  • Assessment
  • Clinical impression/diagnosis
  • Plan for care
  • Problem list
  • Health risk factors identified
  • All CPT And ICD-9-CM codes reported must be supported by documentation in the medical record

I have illustrated what some of the codes for behavioral and mental disorders will look like in ICD-10-CM. As you can see from the list below, it is a much more expansive list than what we currently utilize in ICD-9-CM. When ICD-10-CM goes into effect on Oct. 1, 2014, billing and coding professionals will have better reporting capabilities, which overall will help improve outcomes from studies that are done from tracking codes such as these and aid in providing better care for those affected by these illnesses/disorders.

ICD-10-CM: Mental and behavior, Behavioral and Neurodevelopmental disorders (F01-F99)

F20-F29: Schizophrenia, schizotypal delusional, and other non-mood psychotic disorders:

F20 Schizophrenia

    • brief psychotic disorder (F23) (F23)
    • cyclic schizophrenia (F25.0) (F25.0)
    • mood [affective] disorders with psychotic symptoms (F30.2, F31.2, F31.5, F31.64, F32.3, F33.3) (F30.2, F31.2, F31.5, F31.64, F32.3, F33.3)
    • schizoaffective disorder (F25.-) (F25)
    • schizophrenic reaction NOS (F23) (F23)
    • schizophrenic reaction in:
      • alcoholism (F10.15-, F10.25-, F10.95-) (F10.15, F10.25, F10.95)
      • brain disease (F06.2) (F06.2)
      • epilepsy (F06.2) (F06.2)
      • psychoactive drug use (F11-F19 with .15. .25, .95) (F11-F19)
      • schizotypal disorder (F21) (F21)

F20.0 Paranoid schizophrenia

      • Paraphrenic schizophrenia

F20.1 Disorganized schizophrenia

      • Hebephrenic schizophrenia
      • Hebephrenia

F20.2 Catatonic schizophrenia

      • Schizophrenic catalepsy
      • Schizophrenic catatonia
      • Schizophrenic flexibilitas cerea

F20.3 Undifferentiated schizophrenia

      • Atypical schizophrenia

F20.5 Residual schizophrenia

      • Restzustand (schizophrenic)
      • Schizophrenic residual state

F20.8 Other schizophrenia
F20.81 Schizophreniform disorder

      • Schizophreniform psychosis NOS

F20.89 Other schizophrenia

      • Cenesthopathic schizophrenia
      • Simple schizophrenia

F20.9 Schizophrenia, unspecified

      • F30-F39: Mood [affective] disorders
      • F60-F69: Disorders of adult personality and behavior
      • F70-F79 Intellectual disabilities
      • F80-F89: Pervasive and specific developmental disorders
      • F90-F98: Behavioral and emotional disorders with onset usually occurring in childhood and adolescence

F30 Manic episode

      • bipolar disorder, single manic episode
      • mixed affective episode
      • bipolar disorder (F31.-) (F31)
      • major depressive disorder, recurrent (F33.-) (F33)
      • major depressive disorder, single episode (F32.-) (F32)

F30.1 Manic episode without psychotic symptoms
F30.10 Manic episode without psychotic symptoms, unspecified
F30.11 Manic episode without psychotic symptoms, mild
F30.12 Manic episode without psychotic symptoms, moderate
F30.13 Manic episode, severe, without psychotic symptoms

F30.2 Manic episode, severe with psychotic symptoms

      • Manic stupor
      • Mania with mood-congruent psychotic symptoms
      • Mania with mood-incongruent psychotic symptoms

F30.3 Manic episode in partial remission
F30.4 Manic episode in full remission

F30.8 Other manic episodes

      • Hypomania

F30.9 Manic episode, unspecified

      • Mania NOS

F60 Specific personality disorders

F60.0 Paranoid personality disorder

      • Expansive paranoid personality (disorder)
      • Fanatic personality (disorder)
      • Paranoid personality (disorder)
      • Querulant personality (disorder)
      • Sensitive paranoid personality (disorder)
      • paranoia (F22) (F22)
      • paranoia querulans (F22) (F22)
      • paranoid psychosis (F22) (F22)
      • paranoid schizophrenia (F20.0) (F20.0)
      • paranoid state (F22) (F22)

F60.1 Schizoid personality disorder

      • Asperger’s syndrome (F84.5) (F84.5)
      • delusional disorder (F22) (F22)
      • schizoid disorder of childhood (F84.5) (F84.5)
      • schizophrenia (F20.-) (F20)
      • schizotypal disorder (F21) (F21)

F60.2 Antisocial personality disorder

      • Amoral personality (disorder)
      • Asocial personality (disorder)
      • Dissocial personality disorder
      • Psychopathic personality (disorder)
      • Sociopathic personality (disorder)
      • conduct disorders (F91.-) (F91)
      • borderline personality disorder (F60.3) (F60.3)

F60.3 Borderline personality disorder

  • Aggressive personality (disorder)
  • Emotionally unstable personality disorder
  • Explosive personality (disorder)
  • antisocial personality disorder (F60.2) (F60.2)

F60.4 Histrionic personality disorder

  • Hysterical personality (disorder)
  • Psychoinfantile personality (disorder)

F60.5 Obsessive-compulsive personality disorder

  • Anankastic personality (disorder)
  • Compulsive personality (disorder)
  • Obsessional personality (disorder)
  • obsessive-compulsive disorder (F42) (F42)

F60.6 Avoidant personality disorder

  • Anxious personality disorder

F60.7 Dependent personality disorder

  • Asthenic personality (disorder)
  • Inadequate personality (disorder)
  • Passive personality (disorder)

F60.8 Other specific personality disorders
F60.81 Narcissistic personality disorder

F60.89 Other specific personality disorders

  • Eccentric personality disorder
  • “Haltlose” type personality disorder
  • Immature personality disorder
  • Passive-aggressive personality disorder
  • Psychoneurotic personality disorder
  • Self-defeating personality disorder

F60.9 Personality disorder, unspecified

  • Character disorder NOS
  • Character neurosis NOS
  • Pathological personality NOS

F90 Attention-deficit hyperactivity disorders

  • attention deficit disorder with hyperactivity
  • attention deficit syndrome with hyperactivity
  • anxiety disorders (F40.-, F41.-) (F40, F41)
  • mood [affective] disorders (F30-F39) (F30-F39)
  • pervasive developmental disorders (F84.-) (F84)
  • schizophrenia (F20.-) (F20)

F90.0 Attention-deficit hyperactivity disorder, predominantly inattentive type
F90.1 Attention-deficit hyperactivity disorder, predominantly hyperactive type
F90.2 Attention-deficit hyperactivity disorder, combined type
F90.8 Attention-deficit hyperactivity disorder, other type

F90.9 Attention-deficit hyperactivity disorder, unspecified type

  • Attention-deficit hyperactivity disorder NOS
  • Attention-deficit hyperactivity disorder of childhood or adolescence NOS

Final Thoughts
Again I will reiterate the importance of accurate code reporting in order to ensure proper reimbursement from Payers and to keep your accounts receivable in the black and maintain positive cash flow to the practice. It is also vital to ensure accurate code reporting so that Payers will have a clear picture of a member’s mental health profile and be able to provide better benefits and treatment overall.

I refer again to the National Institute of Mental Health (NIMH), which provides an extensive resource on such statistics and can be accessed for more information by clicking here.

For more information on coding for mental health, please refer to the American Academy of Pediatrics website here.

Happy Coding!
Holly

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