1. ICD-10-cm Coding for Psychiatry and behavioral health
Trizetto Webinar: April 16, 2015

2. Our agenda
Review coding in behavioral health, identify documentation gaps
Understand when to use personal and family history codes
Describe reporting suspected and confirmed abuse
Our source: Chapter 5, Mental Behavioral, and Neurodevelopmental Disorders (F01—F99)
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3. All ICD-10 Chapters start with blocks
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
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4. All ICD-10 Chapters start with blocks
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 F99 Unspecified mental disorder
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5. Dementia F01.- Vascular dementia
Code first the underlying physiological condition or sequelae of cerebrovascular disease
F02.- Dementia in other diseases classified elsewhere
Code first: List of 21 conditions that are coded in the first position, including Alzheimer’s (G30.-) Parkinson’s (G20)
That means, code the Alzheimer’s first, then the dementia
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6. Case coding G20 Parkinson’s disease
Pt with Parkinson’s disease presents with spouse who describes pt’s increasing confusion, memory problems, combativeness, wandering and inability to be left alone.
G20 Parkinson’s disease
F02.81 Dementia in other diseases classified else where with behavioral disturbance
Use additional code, if applicable, to identify wandering in dementia in conditions classified elsewhere (Z91.83)
Z91.83 Wandering in diseases classified elsewhere

7. Use, dependence, abuse
Dependence and abuse are clinical terms described by DSM IV and DSM V
Clinician determines if the patient’s use of a substance is use, dependence or abuse
Specific coding depends on knowing this
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8. Hierarchy: General Guidelines
If both use and abuse are documented, assign only the code for abuse
If both abuse and dependence are documented, assign only the code for dependence
If use, abuse and dependence are documented, assign only the code for dependence
If both use and dependence are documented, assign only the code for dependence
Dependence documented? Assign it.

9. Substance abuse in ICD-10
Identify substance
Identify type of disorder (use, abuse, dependence)
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10. Substance abuse in ICD-10
For use, identify: uncomplicated Or
with complications (check codes by substance)
with intoxication, withdrawal, perceptual disorder, delirium, hallucinations, anxiety, sexual dysfunction, sleep disorder, with substance-induced psychotic disorder, with other substance-induced disorders, unspecified complication
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11. Substance abuse in ICD-10
For abuse: uncomplicated Or
with complications (check codes by substance)
with intoxication, delirium, hallucinations, perceptional disorder, substance induced psychotic disorder, substance induced anxiety, sleep disorder, sexual dysfunction, other substance induced disorders, unspecified complication
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12. Substance abuse in ICD-10
For dependence, identify uncomplicated, in remission Or
with complications (check codes by substance)
with intoxication, delirium, perceptual disturbance, delusions, with substance induced anxiety, sexual disorder or sleep disorder, with other substance induced disorders, with withdrawal, unspecified complication
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13. Substance abuse--examples
F10.18 Alcohol abuse with alcohol-induced anxiety disorder F10.21 Alcohol dependence, in remission F Alcohol dependence with withdrawal, uncomplicated
For alcohol related disorders, notation to “use additional code for blood alcohol level if applicable, Y90.-”
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14. Could we code? What’s missing?
Physician must indicate abuse versus dependence
F Alc dependence with intoxication, uncomplicated
F Alc dependence with intoxication delirium
F Alc abuse with intoxication uncomplicated
F Alc abuse with intoxication delirium
Brought to ER by police, obviously intoxicated. PMH indicates that this is a chronic problem.
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15. Alcohol disorders F10 There are unspecified codes
F Alc abuse with intoxication, unspecified
F Alc dependence with intoxication, unspecified
Unspecified codes in each section BUT…
Use additional code for blood alcohol level, if applicable (Y90.-)
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16. Alcohol use in ICD-10 Use, abuse, dependence: clinical definitions
Greatly expanded from ICD-9, requiring more information about complications
ICD-9: V11.3 Personal history of mental disorder, alcoholism
ICD-10: Unlike other conditions, this is coded in the mental health chapter, not in the “supplemental classification of factors” chapter
F10.21 Alcohol dependence in remission
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17. Substance abuse F11.- Opiod related disorders
F12.- Cannabis related disorders
F13.-Sedative, hypnotic, or anxiolytic related disorders
F14.-Cocaine related disorders
F15.- Other stimulant related disorders
F16.- Hallucinogen related disorders
F17.-Nicotine dependence
F18.- Inhalant related disorders
F19.- Other psychoactive substance related disorders (includes polysubstance abuse)
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18. Substance abuse F10.-F19.0
Use, abuse, dependence, with/without complications
Examples:
F Cannabis abuse with intoxication delirium
F Cannabis dependence with intoxication delirium
F Cannabis use, unspecified with intoxication
Always a code for uncomplicated in use, abuse and dependence
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19. Case coding
Patient with long term opioid dependence and chronic pain. Presents to therapy session with psychotic delusions, no hallucinations. Treated by pain specialist for pain.
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20. Case coding
F Opioid dependence with opioid- induced psychotic disorder with delusions
If chronic pain addressed:
G89.4 Chronic pain syndrome
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21. Personal history of drug dependence
Index says: see Dependence, drug, by type, in remission
Not codes from Chapter 21 indicating “history of”
Select the “in remission” code in the dependence category of the substance
Dependence
Opioid
In remission
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22. In remission, examples F11.21 Opioid dependence, in remission
F12.21 Cannabis dependence, in remission
F13.21 Sedative, hypnotic or anxiolytic dependence, in remission
F14.21 Cocaine dependence, in remission
And, similar codes for categories F14.- F19.-
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23. F20-F29, F30 F20-F29 Schizophrenia F30 Manic episode
Defined by type of disorder, including brief psychotic disorder and delusional disorder
F30 Manic episode
Excludes1 bipolar disorder (F31.-)
Major depressive disorder, single episode (F32.-)
Major depressive disorder, recurrent (F33.-)
Manic episode, with/without psychotic symptoms, mild, moderate, severe, partial or full remission
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24. Depression F31 Bipolar disorder
F32 Major depressive disorder, single episode
F33 Major depressive disorder, recurrent
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25. Depression
Defined in ICD-10 Episode (single, recurrent) Severity (mild, moderate, severe, with/without psychotic features) Remission (partial, full) Recurrent
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26. Depression example “Current episode”
F31.11 Bipolar disorder, current episode manic without psychotic features, mild
F31.31 Bipolar disorder, current episode depressed, mild
F31.61 Bipolar disorder, current episode mixed, mild
Greatly expanded codes from ICD-9 to ICD-10 for bipolar and major depressive disorders
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27. Depression examples
F32.1 Major depressive disorder, single episode, moderate
F33.1 Major depressive disorder, recurrent, moderate
Still many unspecified codes: try not to use
F32.9 Major depressive disorder, single episode, unspecified
F33.9 Major depressive disorder, recurrent, unspecified
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28. Code this case
Therapist evaluates 32 year old patient with long history of depression, PTSD. No history of manic episodes. One prior suicide attempt. Therapist diagnoses a major depressive episode of moderate severity. No current suicidal ideation. No psychosis.
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29. Therapist documented Major depressive disorder
No features of bipolar disorder
Recurrent
Severity
PTSD
Suicide attempt in history
No psychotic features
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30. Codes
F33.2 Major depressive disorder, recurrent, severe without psychotic features
F43.12 Post-traumatic stress disorder, chronic
Z91.5 Personal history of self-harm
Would your current depression documentation allow you to make a specific diagnosis in ICD- 10?
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31. Anxiety F40 Phobia anxiety disorders F41.0 Panic episode
Specific types defined, some expansion
F41.0 Panic episode
F41.1 Generalized anxiety disorder
F43.10 PTSD, unspecified
F43.11 PTSD, acute
F42.12 PTSD, chronic
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32. Personal and family history of…
Chapter 21: Factors influencing health status and contact with health services (Z00—Z99)
Includes “personal and family history of,” need for immunization, exam codes
Codes for non-compliance with medication
For us: personal and family history of mental health disorders, abuse
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33. Family history Z81.1 Family history of alcohol abuse and dependence
Z81.3 Family history of psychoactive substance abuse and dependence
Z81.8 Family history of other mental and behavioral disorders
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34. Personal history of Z62.- Problems related to upbringing
Z Personal history of physical and sexual abuse in childhood
Z Personal history of psychological abuse in in childhood
Z Personal history of neglect in childhood
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35. Personal history of
Z Personal history of adult physical and sexual abuse
Z Personal history of adult psychological abuse
Z Personal history of adult neglect
All of these codes have Excludes1 note: Excludes1 current adult physical abuse, current adult sexual abuse
More about that soon!
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36. Excludes1--example
Z Personal history of physical and sexual abuse in childhood
Excludes1 current child physical abuse (T74.12, T76.12)
Current child sexual abuse (T74.22, T76.22)
That means, if the patient is experiencing current abuse, use that code, not history of. May not be used together.
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37. Excludes—two types in ICD-10
Excludes1: A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE.” Excludes2: A type 2 Excludes note represents “Not included here.” If patient has both conditions, may code both.
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38. Chapter 19 –injury, trauma and adverse effects
Adult and child abuse are in the injury and adverse events chapter
Use these codes for suspected or confirmed adult and child abuse
For history of abuse, see the Z codes in Chapter 21
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39. Injuries require a 7th character
Seventh character always goes in 7th position— may need placeholder code x if diagnosis code has only, 3, 4 or 5 digits A: initial encounter: used when patient is receiving active treatment for condition D: subsequent encounter: used after active treatment during the healing or recover phase S: sequela: complications or conditions that arise as a direct result of the condition
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40. T74 Adult and child abuse, neglect or other maltreatment, confirmed
Use these codes for confirmed adult and child neglect or abandonment, physical abuse, sexual abuse, psychological abuse
Will require a placeholder x code in the 6th position
Will require a 7th character extender, A, D, S
Use additional code, if applicable, to identify any associated current injury
Use additional code to identify perpetrator, if known, Y07.-
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41. T76 Adult and child abuse, neglect and other maltreatment, suspected
Use these codes for suspected adult and child neglect or abandonment, physical abuse, sexual abuse, psychological abuse
Will require a placeholder x code in the 6th position
Will require a 7th character extender, A, D, S
Use additional code, if applicable, to identify any associated current injury
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42. T74 examples
T74.12 Child physical abuse, confirmed Requires a seventh character T74.12xA Child physical abuse, confirmed, initial encounter T74.12xD Child physical abuse, confirmed, subsequent encounter T74.12xS Child physical abuse, confirmed, sequela
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43. Changes in ICD-10
Increased specificity in depression and substance abuse codes—will your documentation allow this?
Personal history of substance abuse codes in mental health chapter
Child and adult abuse codes will require 7th character
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44. To do list: Have cash or line of credit on hand Buy an ICD-10 book
Look at clinical documentation: what needs to be added to select ICD- 10 codes?
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45. Thank you Betsy Nicoletti www.betsynicoletti.com www.codapedia.com
Follow me on twitter @BetsyNicoletti
©2015 Betsy Nicoletti