Implementation of ICD 10 deadline The U.S. health care system relies on a set of codes, referred to as ICD-9, to report diagnoses which was introduced in the late 1970s, the ICD-9 code set will soon be replaced by the more detailed ICD-10, with a deadline for the transition of October 1, 2015.

The transition from ICD-9 to ICD-10 is a major transition, as it reflects a five-fold increase in diagnosis codes, to roughly 69,000 codes. If a medical practice or insurance payer doesn't switch to ICD-10 by the deadline, claims cannot be processed.

Mental Health providers have over 300 new diagnosis codes that range from F01-F99

One of the MYTHS of ICD10 is that the increased number of codes will make the new coding system impossible to use. In FACT, just as an increase in the number of words in a dictionary doesn’t make it more difficult to use, the greater number of codes in ICD10 doesn’t make it more complex to use. The greater number of codes in ICD10 make it easier for you to find the right code.

CHALLENGES FOR MENTAL HEALTH PROVIDERS USING ICD10

MULTIPLE DIAGNOSIS Precedence should be given to the diagnosis that best represents the Nature of the Presenting Problem and is most relevant to the purpose of the visit ** Best practice: record the diagnosis in the numerical order in which they appear in the ICD10 classification

TERMINOLOGY CHANGE The term “disorder” is used throughout the classification, in order to keep it separate from terms that often seem to be interchanged like “disease” and “illness”. The term “disorder” is used to allow the existence of a clinically recognizable set of symptoms and/ or behavior often associated with distress and disruption of personal function.

SUBSTANCE ABUSE, USE AND DEPENDENCY Although ICD9 doesn’t distinguish between use, abuse and dependency, ICD10 does. Many of the codes in this section also specify complications such as mood disorders, delusion, delirium, perceptual disturbances and much more. Providers can only submit one code per substance, so be clear the documentation associated with the psychoactive substance is clearly stated.

BEHAVIORHAL & MENTAL HEALTH DOCUMENTION TIP SHEET FOR ICD10 DOCUMENTATION BEHAVIORHAL & MENTAL HEALTH DOCUMENTION TIP SHEET FOR ICD10

ADD and ADHD Document type: - Predominantly inattentive - Predominantly hyperactive - Combined type Adjustment Disorder - Depressed mood - Anxiety - Mixed anxiety and depressed mood - Disturbance of conduct - Mixed disturbance of emotions and conduct Alcohol/ Drug Abuse and Dependence Differentiate between alcohol/substance abuse versus dependence -Do not document “use” as a substitute for abuse or dependence Dependence, document if in remission which is based on your clinical judgment Document any substance induced disorders or complications: -Anxiety disorder -Delirium -Delusions -Hallucinations -Psychotic disorder

- With behavioral disturbance - Without behavioral disturbance Bipolar Disorder Document current episode: - Hypomanic - Manic - Depressed - Mixed Specify severity for manic and depressed episodes: - Mild - Moderate - Severe w/o psychotic symptoms - Severe with psychotic symptoms Indicate status: - Full remission - Partial remission Conduct Disorder Document: - Confined to family context - Childhood-onset type - Adolescent-onset type - Oppositional defiant Dementia - With behavioral disturbance - Without behavioral disturbance Document underlying condition (e.g. Alzheimer's, Parkinson's, Vit B deficiency Document vascular dementia as a result of infarction

Depression Document type: - Major depression (see Major Depressive Disorder below) - Adjustment disorder with or without depression and/or anxiety, e.g., grief reaction - Anxiety depression - Depressive neurosis Drug Underdosing Document: - Intentional versus - Unintentional Document reason for underdosing: - Financial hardship or - Age related dementia Eating Disorders Specify Anorexia Nervosa type: - Restricting type - Binge eating/purging type - Atypical Document Bulimia Nervosa type: - Bulimia (Hyperorexia nervosa)

Insomnia Specify: - Primary - Adjustment - Paradoxical - Psychophysiological - Primary hypersomnia - Insufficient sleep syndrome Document if insomnia due to other mental disorder List other underlying or related conditions: - Nightmares - Sleepwalking Document any contribution from alcohol or drug use on condition, specify name of drug Major Depressive Disorder Document episode: - Single - Recurrent Document severity: - Mild - Moderate - Severe w/o psychotic symptoms - Severe w/ psychotic symptoms Indicate status: - Full remission - Partial remission Post-traumatic Stress Disorder (PTSD) Document acuity: - Acute - Chronic

Schizophrenia Document type: - Paranoid - Disorganized - Catatonic - Undifferentiated - Residual - Other Differentiate between: - Schizophrenia - Schizotypal disorder - Delusional disorder - Brief psychotic disorder - Shared psychotic disorder Document schizoaffective type: - Bipolar type - Depressive type Substance Use, Abuse and Dependence Specify: - Use - Abuse - Dependence Do NOT document 'use' for abuse or dependence Document any substance induced disorders or complications Tobacco Use Disorder - Cigarettes - Chewing tobacco Delineate between: - Tobacco use/abuse - Tobacco dependence Document state of dependence: - In remission - With withdrawal - Without withdrawal Document if used during pregnancy, childbirth, puerperium Describe history, including product and time