Basic ICD-10-CM/PCS Coding 2013 Edition

1. Basic ICD-10-CM/PCS Coding2013 Edition Chapter 8: Mental, Behavioral and Neurodevelopmental Disorders (F01–F99)

2. Learning Objectives • Review the chapter’s learning objectives and key terms • At the conclusion of this chapters, what must you know about the coding of mental, behavioral, and neurodevelopmental disorders and the related therapeutic procedures?

3. ICD-10-CM Chapter 5: Mental and Behavioral Disorders (F01–F99) Chapter 5 organizes mental and behavioral disorders in the following 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, delusional and other non-mood psychotic disorders

4. ICD-10-CM Chapter 5: Mental and Behavioral Disorders (F01–F99) F30–F39: Mood [affective] disorders F40–F49: Anxiety, dissociative, stress-related, somatoform and other nonpsychotic disorders F50–F59: Behavioral syndromes associated with physiological disturbances and physical factors F60–F69: Disorders of adult personality and behavior

5. ICD-10-CM Chapter 5 The chapter allows for more specific coding of these conditions consistent with the language of behavioral health and substance abuse services as documented in health and client records today. For example, mental and behavioral disorders due to psychoactive substance abuse linking the substance involved with the specific disorder caused by it.

6. ICD-10-CM Chapter 5 Improved coding for substance abuse conditions Unique codes for alcohol and drug “use,” “abuse,” and “dependence” A history of drug or alcohol dependence is coded as “in remission” Use additional code note exists to also code the blood alcohol level as an external cause

7. ICD-10-CM and DSM-IV-TR Codes in chapter 5 of ICD-10-CM parallel the codes in The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) DSM-IV-TR is multiaxial system involving an assessment on five different axes

8. ICD-10-CM and DSM-IV-TR Axis I: Clinical Disorders and Other Conditions That May be a Focus of Attention Includes all psychiatric disorders except personality disorders and mental retardation Axis II Includes personality disorders and mental retardation Axis III Indentifies the presence of general medical conditions

9. ICD-10-CM and DSM-IV-TR Axis IV Used to note clinically relevant psychosocial and environmental problems Axis V Used to indicate the individual’s overall psychological, social, and occupational functioning Axis I, II and III—provide diagnostic information

10. ICD-10-CM Coding Guidelines and Instructional Notes for Chapter 5 • Chapter specific guidelines are available for coding mental, behavioral and neurodevelopment disorders in the ICD-10-CM Official Guidelines for Coding and Reporting. • Chapter specific guidelines: • Pain disorders related to psychological factors • Mental and behavioral disorders due to psychoactive substance use • In remission status based on provider documentation • Hierarchy for sequencing substance use and abuse conditions • Psychoactive substance use

11. ICD-10-CM Coding Guidelines and Instructional Notes for Chapter 5 • Diagnosis codes must be used and reported to the highest level of specificity provided by the physician • An understanding of the diseases and clinical terminology in the behavioral health setting is crucial for coding • Coders should make no assumptions about the meaning of the physician diagnostic statement; when in doubt the physician should be asked for clarification • Direction notes are included to direct the coder how to use the codes appropriately

12. ICD-10-CM Coding Guidelines and Instructional Notes for Chapter 5 • Multiple coding directions • Instructional note to assign an additional code to identify any associated behavioral disorder • Example: Use additional code, if applicable, to identify wandering in vascular dementia • Instructional note to code first the underlying physiological condition • Instructional note to code first the associated physical disorders • Instructional note to use additional code to identify other conditions

13. ICD-10-CM Coding Guidelines and Instructional Notes for Chapter 5 • Inclusion and Exclusion Notes • Includes notes: • List specific drug names for specific drug related disorders • Identify other diagnostic terms for specific mental health disorders • Excludes notes: • Identify terms that are mutually exclusive that cannot be coded in the same patient • Advise the coder when both conditions stated in the code title and the excludes2 note can be coded in the same patient

14. Alcoholism and Alcohol Abuse and Use • Alcoholism or alcohol dependence is defined as a chronic condition in which a patient has become dependent on alcohol with increased tolerance and is unable to stop using it, even while facing strong incentives such as impairment of health, deteriorated social interactions, and interference with job performance. Such patient often experience physical signs of withdrawal during any sudden cessation of drinking. • Specific criteria exists in DSM-IV-TR to define alcohol dependence

15. Alcoholism and Alcohol Abuse and Use • Alcoholism is classified to subcategory F10.2-, Alcohol dependence • The fifth characters identify when alcoholism is uncomplicated, or in remission or associated with another condition or complication of the disease • Other codes exist for alcohol abuse (F10.1-) with fifth and sixth characters to further specify the extent of the condition • Another set of codes are available for coding when the provider uses the terminology of “alcohol use” without further specification

16. Drug Dependence and Abuse • Drug dependence or drug addiction is a chronic mental and physical condition related to the patient’s pattern of taking a drug or a combination of drugs. It is characterized by behavioral and physiological responses such as a compulsion to take the drug, to experience its psychic effects, or to avoid the discomfort of its absence. There is increased tolerance and an inability to stop the use of the drug, even with strong incentives. • DMS-IV-TR has criteria to define substance or drug dependence.

17. Drug Dependence and Abuse • ICD-10-CM has a series of three-character categories for drug-related disorders • F11 Opioid 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

18. Drug Dependence and Abuse • All of the categories for drug related disorders have four-character codes for: • Drug abuse • Drug dependence • Drug use, unspecified • These codes are further divided into drug related disorders that exist with intoxication, mood disorder, psychotic disorder, and other drug induced disorders.

19. Drug Dependence and Abuse • Codes exist in other chapters of ICD-10-CM to describe the current or past use of nicotine or tobacco, such as • Personal history of nicotine dependence • Current use of tobacco • Pregnant woman using tobacco

20. Other Mental, Behavioral and Neuro-developmental Disorders • Categories F20–F29 • Block of codes that classify schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders • Includes different forms of schizophrenia: paranoid, disorganized, catatonic, undifferentiated, residual among other forms

21. Other Mental, Behavioral and Neuro-developmental Disorders • Categories F30–F39 • Block of codes include mood (affective) disorders including bipolar disorders also known as manic-depressive illness • Code F41.1 classifies generalized anxiety disorder • Codes F50.01 and F50.02 classify different types of anorexia nervosa

22. Other Mental, Behavioral and Neuro-developmental Disorders • Categories F60–F69 • Block of codes for disorders of adult personality and behavior including borderline personality disorder • Categories F70–F79 • Include codes for intellectual disabilities, a more current term for mental retardation. These codes include an instructional note to code first any associated physical or developmental disorder

23. ICD-10-PCS Coding for Behavioral Health Procedures • Behavioral health procedures exist in ICD-10-PCS in the Mental Health (GZ1–GZJ) and Substance Abuse (HZ2–HZ9) sections • Detoxification is the active management of withdrawal symptoms in a patient who is physically dependent on alcohol and/or drugs • Rehabilitation is a structured program that results in controlling the alcohol or drug use and in replacing alcohol or drug dependence with activities that are nonchemical in nature

24. ICD-10-PCS Coding for Behavioral Health Procedures • Mental health therapies include psychological tests, crisis intervention, medication management, individual psychotherapy, counseling, family psychotherapy, electroconvulsive therapy, biofeedback, hypnosis, narcosynthesis, group psychotherapy, and light therapy

25. ICD-10-PCS Coding for Behavioral Health Procedures • Index entries for mental health and substance abuse treatment procedures include “substance abuse treatment” and under the titles of the various procedures for both mental health and substance abuse therapy: • Counseling • Detoxification services • Medication management • Pharmacotherapy • Psychotherapy

26. ICD-10-PCS Coding for Behavioral Health Procedures • Seven characters for mental health procedures represent: • Character 1 = Mental Health (G) • Character 2 = Body system, which is always none (Z) • Character 3 = Root type, which includes 12 types of mental health procedures • Character 4 = The type qualifier indicates more about the root type procedure, for example, if counseling is vocational or educational • Character 5, 6, and 7 = All of these characters are not specified and always have the value of “none” or Z

27. ICD-10-PCS Coding for Behavioral Health Procedures • Seven characters for substance abuse treatments represent: • Character 1 = Substance abuse treatment (H) • Character 2 = Body system, which is always none (Z) • Character 3 = Root type, which includes 7 types of substance abuse treatments • Character 4 = The type qualifier depends on the root type procedure, such as the type of individual and group counseling • Character 5, 6, and 7 = All of these characters are not specified and always have the value of “none” or Z

28. Exercises • Practice coding the conditions included in Chapter 5 of ICD-10-CM for mental, behavioral and neurodevelopment disorders as well as the procedures used to treat these conditions by completing the review exercises for Chapter 8.