In 2016, there were 44.7 million adults with a mental illness in the U.S., representing 18.3% of all adults.[i] Mental illnesses are comprised of many different conditions that range in degrees of severity. Two broad categories are used to describe these conditions: Any Mental Illness (AMI), which encompasses all recognized mental illnesses and Serious Mental Illness (SMI), which is a smaller and more severe subset of AMI.

There were an estimated 44.7 million adults with AMI and 10.4 million adults with SMI in 2016. Of those, 19.2 million adults with AMI (43%) and 6.7 million with SMI (68.8%) received mental health treatment.[ii]  Coding mental and behavioral health in ICD-10 is becoming more prevalent and can sometimes be confusing.

 

Correct coding tips for five common conditions

A webinar addressing coding guidelines for mental and behavioral health was presented by Nena Scott, MSEd, RHIA, CCS, CCS-P, CCDS, Director of Coding Quality and Professional Development at TrustHCS in June 2017. It covered coding guidelines for ICD-10 chapters 5 and 15. Coding tips for five common mental and behavioral conditions were also included in the webinar.

 

Using ICD-10 Chapters 5 and 15

Chapter 5 contains codes and coding guidelines for mental, behavioral and neurodevelopmental disorders including conditions due to psychoactive substance abuse. Chapter 15 addresses pregnancy, childbirth and the puerperium with specific codes for alcohol and tobacco use during this period.

It is important for coders to fully review and understand the guidelines contained in chapters 5 and 15. Here are three important coding tips from this section of the webinar with additional details available in the webinar download.

  • The use of “in remission” requires thorough knowledge of the definition and provider’s documentation and clinical judgement.
  • Only one code should be assigned to identify a pattern of psychoactive substance use, abuse and dependence based on provider documentation.
  • Associated codes should only be assigned based on provider documentation.

As with all diseases, conditions and procedures, accurate clinical documentation is the foundation for correct ICD-10 coding. The remainder of the webinar presented guidelines for coding five common conditions.

 

Coding Drug, Alcohol and Tobacco Abuse and Dependence

When the provider refers to use, abuse and dependence of the same substance (e.g. alcohol, opioid, cannabis, tobacco, etc.) only one code should be assigned to identify the pattern of use. The following chart provides a quick reference for code selection:

Documentation Code
Use and abuse Only abuse
Abuse and dependence Only dependence
Use, abuse and dependence Only dependence
Use and dependence Only dependence

 

Mood or Affective Disorders

Affective disorders, more commonly known as mood disorders, are mental disorders with biological, behavioral, social and psychological factors, characterized by mood disturbance. The most common affective disorders are bipolar disorders (F31), major depressive disorders (F32-F33) and anxiety disorders (F40).

Mood disorders include the following and are categorized as such in ICD-10 to include:

  • Manic episode
  • Bipolar disorder – specify the current episode as manic, depressed or mixed
  • Major depression – specify as a single or recurrent episode and the current severity
    • 0 – mild
    • 1 – moderate
    • 2 – severe, without psychotic features
    • 3 – severe, with psychotic features
  • Persistent mood [affective] disorder – detail cyclothymic, dysthymic or other type

Documentation must identify: “with” or “without” psychotic symptoms or features when applicable; if patients are in partial or full remission; whether the episode is mild, moderate or severe.

 

Schizophrenia and Schizoaffective Disorder

Schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. It may manifest in some combination of hallucinations, delusions and disordered thinking and behavior.  Signs and symptoms are divided into three categories – positive, negative and cognitive.

Schizoaffective disorder is a condition in which a person experiences a combination of schizophrenia symptoms – such as hallucinations or delusions – and of mood disorder symptoms, such as mania or depression.

The complete presentation audio recording and PDF of the slides may be accessed here

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[i] https://www.nimh.nih.gov/health/statistics/mental-illness.shtml

[ii] https://www.nimh.nih.gov/health/statistics/mental-illness.shtml#part_154787