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Basic ICD-9-CM Coding 2011 Edition

Basic ICD-9-CM Coding 2011 Edition. Chapter 8: Mental Disorders. Mental Disorders . Categories 290–299 Psychoses Categories 300–316 Neurotic disorders Personality disorders Other nonpsychotic mental disorders Categories 317–319 Mental retardation. DSM-IV-TR.

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Basic ICD-9-CM Coding 2011 Edition

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  1. Basic ICD-9-CM Coding2011 Edition Chapter 8: Mental Disorders

  2. Mental Disorders • Categories 290–299 • Psychoses • Categories 300–316 • Neurotic disorders • Personality disorders • Other nonpsychotic mental disorders • Categories 317–319 • Mental retardation

  3. DSM-IV-TR • Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition • Allows clinicians to diagnosis and treat • All DSM-IV categories are included in ICD-9-CM

  4. DSM-IV-TR (continued) • Multi-axial system • Axes I and II include all psychiatric orders, personality disorders and mental retardation, • Axis III identifies the presence of general medical conditions • Axes IV and V describe psychosocial and environmental problems and the individual’s overall psychological, social and occupational functioning

  5. Glossary of Mental Disorders • Removed from coding books in 2004 • Student may need a reference tool for understanding psychiatric terms • Some publishers of ICD-9-CM codebooks include glossary definitions within the Tabular List

  6. Updating of Code Descriptions • American Psychiatric Association continues to work with National Center for Health Statistics to ensure a seamless crosswalk between DSM-IV-TR and ICD-9-CM • Continue to update terminology • DSM-IV-TR and ICD-10-CM will have near-perfect compatibility

  7. Multiple Coding • Instructional notes to assign additional codes • Associated neurological disorder • Additional code used for neurological disorder when present with mental health diagnosis • Associated mental disorder and physical condition • Additional codes used for neurosis, psychosis, or physical conditions • Related physical condition, such as arteriosclerosis • Additional codes used for medical conditions

  8. Fifth-Digit Subclassification • Numerous fifth-digit codes are used with chapter 5 codes • Definitions of fifth digits exist • Specific information must be documented in health record in order to assign correct fifth-digit code

  9. Inclusion and Exclusion Notes • Importance of reading all notes • Includes notes further describe category or subcategory • Excludes notes advise of specific forms of a condition that may be classified elsewhere in ICD-9-CM

  10. Psychoses • Review category code titles • Organic psychotic conditions (290–294) • Dementias • Alcohol-induced mental disorders • Drug-induced mental disorders • Transient mental disorders due to conditions classified elsewhere • Persistent mental disorders due to conditions classified elsewhere • 294.10 and 294.11, Dementia in conditions classified elsewhere, requires underlying condition to be coded first; for example, Alzheimer’s disease

  11. Psychoses (continued) • Other psychoses (295–299) • Schizophrenic disorders • Episodic mood disorders • Affective disorders • Bipolar disorders (mania/depression) • Delusional disorders • Other nonorganic psychoses • Pervasive developmental disorders

  12. Categories 300–316 • Review category code titles • Anxiety, dissociative and somatoform disorders (300) • Anxiety • Phobia • Obsessive-compulsive • Personality disorders (301) • Paranoid • Schizoid • Histrionic • Sexual and gender identity disorders (302)

  13. Alcoholism and Alcohol Abuse • Category 303, Alcohol dependence syndrome (alcoholism) • Chronic condition • Addiction is physical dependence • Subcategory 305.1, Alcohol Abuse • Problem drinking without physical dependence • Use caution not to confuse the two conditions • Protect patient privacy to encourage treatment

  14. Drug Dependence and Abuse • Category 304, Drug dependence • Chronic mental and physical condition • Addiction is physical dependence • Category 305, Nondependent abuse of drugs • Use of drugs to excess without dependence • Use caution not to confuse the two conditions • Protect patient privacy to encourage treatment

  15. Fifth Digits for Alcohol/Drug Dependence and Abuse 0 - Unspecified • Inadequate documentation in health record to determine specific form of disease • Do not make assumptions based on statements made in the health record

  16. Fifth Digits (continued) 1 - Continuous • Alcohol: Daily intake of large amounts; regular drinking on weekends or days off from work • Drug: Daily use or almost daily use of drug(s)

  17. Fifth Digits (continued) 2 - Episodic • Alcohol: Alcoholic binges lasting weeks or months followed by long periods of sobriety • Drug: Indicates short periods between drug use or use on the weekends

  18. Fifth Digits (continued) 3 - Remission • Complete cessation of alcohol or drug intake or the period during which a decrease toward cessation is taking place

  19. Principal Diagnosis Rules • For admission of patients with alcohol and/or drug dependence and associated mental disorders, circumstances of admission are considered in selecting principal diagnosis • Follow the UHDDS principal diagnosis definition

  20. Principal Diagnosis Rules (continued) • Patient admitted in withdrawal or withdrawal develops after admission • Withdrawal code is principal diagnosis • Categories 291 or 292 codes describe withdrawal symptoms • Substance abuse is secondary diagnosis • Additional code(s) for substance dependence or abuse

  21. Principal Diagnosis Rules (continued) • Patient is admitted with diagnosis of substance-related mental condition • Mental condition is principal diagnosis • Substance dependence or abuse is additional diagnosis or diagnoses

  22. Principal Diagnosis Rules (continued) • Patient is admitted for detoxification or rehabilitation or both: there is no related mental condition • Alcohol or drug dependence/abuse is principal diagnosis

  23. Principal Diagnosis Rules (continued) • Patient is admitted for unrelated condition and has a diagnosis of alcohol and/or drug dependence or abuse • Unrelated condition is principal diagnosis • Substance dependence/abuse is secondary diagnosis or diagnoses

  24. Principal Diagnosis Rules (continued) • Patient is admitted for treatment or evaluation of a physical complaint related to alcohol and/or drug dependence or abuse • Physical condition is principal diagnosis • Substance dependence or abuse is secondary diagnosis or diagnoses

  25. Therapy for Alcohol or Drug Dependence • Detoxification = active management of withdrawal symptoms in a patient who is physically dependent on alcohol/drugs • Rehabilitation = structured program that results in controlling the alcohol or drug use and replacing it with activities that are nonchemical in nature

  26. Therapy for Alcohol or Drug Dependence (continued) • Procedure codes for • Alcohol rehabilitation, 94.61 • Alcohol detoxification, 94.62 • Alcohol rehabilitation and detoxification, 94.63 • Procedure codes for • Drug rehabilitation, 94.64 • Drug detoxification, 94.65 • Drug rehabilitation and detoxification, 94.66

  27. Therapy for Alcohol or Drug Dependence (continued) • Combined therapies • Combined alcohol and drug rehabilitation, 94.67 • Combined alcohol and drug detoxification, 94.68 • Combined alcohol and drug rehab and detox, 94.69

  28. Other Nonpsychotic Disorders • Review category titles for other conditions • Physiologic malfunction (306) • Special symptoms/psychopathology (307) • Acute reaction to stress (308)

  29. Other Nonpsychotic Disorders (continued) • Adjustment reaction (309) • Specific nonpsychotic mental disorders due to brain damage (310) • Depressive disorder (311) • Disturbance of conduct (312)

  30. Other Nonpsychotic Disorders (continued) • Disturbances of emotions specific to childhood and adolescence (313) • Hyperkinetic syndrome of childhood (314) • Specific delays in development (315) • Psychic factors associated with diseases classified elsewhere (316) • Use additional code for associate physical condition

  31. Mental Retardation • Mild retardation (317) • Other specified mental retardation (318) • Moderate • Severe • Profound • Unspecific mental retardation (319)

  32. ICD-10-CM Snapshot • Chapter 5 of ICD-10-CM, Mental and Behavioral Disorders, F01-F99 • More specific codes available consistent with the language of behavioral health and substance abuse services. Code link the substance involved with the specific disorder caused by it. • For example, F14.280, cocaine dependence with cocaine-induces anxiety disorder.

  33. ICD-10-CM Snapshot • Other codes in ICD-10-CM allow for more specific reporting of the current episode of care. • Includes updated terminology and specificity for conditions such as eating disorders, sleep disorders, impulse disorders, gender identity disorders as well as specific developmental disorders.

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