Physician Practice

ICD-10-CM brings changes to reporting mental disorders

Physician Practice Insider, May 19, 2015

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.

Anxiety disorders

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:

  • F40.21-, animal type phobia
  • F40.22-, natural environment type phobia
  • F40.23-, blood, injection, injury type phobia
  • F40.24-, situational type phobia
  • F40.29-, other specified phobia

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:

Carla presents to the office for evaluation. She was in a major car crash one month ago. She complains of nightmares about the crash and having thoughts of the accident "pop into her head" all the time. She says she now avoids getting in cars if she can and walks when possible. She jumps every time a car passes close, or if she hears a car horn. She is not sleeping well and feels detached and exhausted all the time. She stated she thought the feelings would go away, but they are getting worse and she "just can't take it anymore." She is diagnosed with acute posttraumatic stress disorder.

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

Depression

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:

  • Bipolar disorder (F31.-)
  • Manic episodes (F30.-)
  • Recurrent depressive disorder (F33.-)

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

This article was excerpted from JustCoding.com.

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