ICD-10-CM brings changes to reporting mental disorders

Mental health disorders are common in the United States, with an estimated 19% of Americans 18 or older suffering from a diagnosable mental disorder, according to a 2012 survey from the National Institute of Mental Health (NIMH).

 

This translates to nearly 44 million people, ­according to NIMH. What's more, nearly 10 million people reported suffering from a serious mental illness, which is defined as one that results in serious functional impairment that substantially interferes with or limits major life activities, according to 2012 data.

 

ICD-10-CM includes substantial code changes for reporting mental, behavioral, and neurodevelopmental disorders in Chapter 5 (F01-F99). However, many of the new codes include the same information that is already reported in ICD-9-CM, according to Jennifer E. Avery, CCS, CPC-H, CPC, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, senior regulatory specialist and Boot Camp instructor for HCPro, a division of BLR, in Danvers, Massachusetts.

 

According to NIMH, anxiety disorders affect approximately 40 million Americans 18 years and older each year (18% of the population), making them among the most common mental disorders. Women are 60% more likely to suffer from anxiety- and stress-related disorders than men, and the average age of onset is 11 years old, according to NIMH.

 

ICD-10-CM includes many anxiety- and stress-related disorders. Social phobias (F40.1-) can be reported as unspecified (fifth character 0) or generalized (fifth character 1).

 

Coders can also report specific (isolated) phobias (F40.2-), including:

Obsessive compulsive disorder, another anxiety disorder, only has one option (F42) in ICD-10-CM, making it easy to code.

 

However, coders will have to look for additional detail in documentation in order to code certain other anxiety disorders, according to Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD, director of ICD-10 development and training for AAPC in Chicago.

 

For example, when reporting posttraumatic stress disorder (F43.1-), physicians should document whether it's acute (fifth character 1) or chronic (fifth character 2). Codes for adjustment disorders (F43.2-) can also specify additional signs and symptoms, such as depressed mood (fifth character 1).

 

Hovey provided the following example:

 

 

Coders should report code F43.11 (posttraumatic stress disorder, acute).

 

Major depression is a disorder of the brain that affected 7% of American adults in 2012, according to NIMH. It typically begins between the ages of 15 and 30 and is more common in women.

Coders will report major depressive disorder using codes from ICD-10-CM categories F32 (major depressive disorder, single episode) and F33 (major depressive disorder, recurrent).

 

The ICD-10-CM codes specify whether the depression is mild, moderate, or severe, as well as whether the patient displays psychotic features. Additionally, coders can report when a patient is in full or partial remission.

 

In ICD-9-CM, coders would include that information by adding fifth characters to base codes, but in ICD-10-CM, these details are included in separate categories, according to Avery.

 

For example, a physician documents recurrent major depressive disorder in partial remission. Coders should report F33.41 in ICD-10-CM.

 

Coders should note the Excludes1 notes for single episodes, which prohibit reporting these codes along with:

 

Recurrent depressive disorder also excludes reporting with bipolar disorder and manic episodes.

 

Bipolar disorder is most commonly diagnosed in people between the ages of 18 and 24. Patients experience dramatic mood swings that range from mania to depression, according to NIMH.

Coders will report bipolar disorder mostly using codes from the F31 code category. Codes for single manic episodes are located in category F30.

 

Underneath the code category heading for F31 is an Includes note, used to further define or give examples of conditions that category encompasses. For bipolar disorder, the Includes note lists:

The category also has an Excludes1 note, listing the following mutually exclusive diagnoses:

This category has an Excludes2 note for cyclothymia (F34.0). If a physician documents both bipolar disorder and cyclothymia in a single patient, coders should report codes for both conditions.

ICD-10-CM codes for bipolar disorder specify the following information:

Physicians should include that information in documentation so coders can choose the most accurate code, according to Hovey.

 

For example, a physician documents that a patient is in full remission for Type I bipolar disorder without psychotic features, with the most recent episode manic. Coders should report F31.74. 

 

Eating disorders are illnesses such as eating extremely small or large amounts of food, causing a ­serious disturbance to a patient's everyday diet, according to NIMH. Serious concern about body weight or shape can also be a sign of an eating disorder, according to NIMH.

 

Eating disorders are located in category F50 and list the following Excludes1 note:

This excludes note applies to all codes in category F50, so coders should never report an F50 code with one of the three excluded codes.

 

Category F50 also has an Excludes2 note for feeding disorder in infancy or childhood (F98.2-), which applies to patients through age 17.

 

Anorexia nervosa (F50.0-) is an eating disorder in which the patient has an intense fear of gaining weight and has a distorted body image.

 

There are two types of anorexia nervosa. Patients who have the restricting type (F50.01) lose weight by restricting calories. Those with the binge eating/purging type (F50.02) lose weight by vomiting or using laxatives or diuretics to reduce calorie intake.

 

The physician must document the specific type of anorexia nervosa or coders will need to report an unspecified code (F50.00).

 

Coders should check each subcategory within F50 for additional notes. For example, anorexia nervosa (F50.0-) has two more Excludes1 notes:

Patients with bulimia nervosa (F50.2), or hyperorexia nervosa, consume a large amount of food in a short period of time and then purge, fast, or overexercise to get rid of the calories. This code has an Excludes1 note for anorexia nervosa of the binge eating/purging type.

 

ICD-10-CM code F50.8 (other eating disorders) is used for diagnoses such as pica in adults and psychogenic loss of appetite. Pica is a condition in which patients have a compulsion to eat nonfood items, such as clay, dirt, erasers, paint, or sand.

 

This condition is more common in children; as many as 32% of children ages 1-6 exhibit this behavior, according to the NIMH. In order for it to be considered a disorder, patients must exhibit the behavior for at least one month at an age that is not considered developmentally appropriate.

 

The code for reporting pica in infants and children (F98.3) is not located with other eating disorders in category F50, but is part of F98 (other behavioral and emotional disorders with onset usually occurring in childhood and adolescence).

 

Category F98 also contains the code for rumination disorder of infancy (F98.21). This disorder occurs when a child brings food that was already swallowed back into his or her mouth and rechews it. To be considered a disorder, it must occur in children who had previously been eating normally and must occur regularly for at least one month. 

 

Vascular dementia is caused by impaired blood flow to the brain, which damages the brain's blood vessels. The condition is the second most common form of dementia following Alzheimer's disease, according to the National Institute on Aging, with similar symptoms. Alzheimer's and vascular dementia can also occur at the same time.

 

In ICD-9-CM, coders have four options for reporting vascular dementia:

 However, in ICD-10-CM, they will have two:

The ICD-10-CM category also includes an important note instructing coders to first report the underlying physiological condition or sequelae of cerebrovascular disease for patients with vascular dementia.

In addition, code F01.51 includes a note to use an additional code, if applicable, to identify wandering in vascular dementia (Z91.83).

 

Editor's note: This article was originally published in the April issue of Briefings on APCs. Email your questions to editor Steven Andrews at sandrews@hcpro.com.