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I-10 Corner: Chapter 5 - Mental, Behavioral, and Neurodevelopmental Disorders (F01-F99)

Published on 

Tuesday, July 8, 2014

 | Coding 
 | Documentation 

Our next topic for the I-10 corner is the mental health chapter, Mental, Behavioral, and Neurodevelopmental Disorders. Chapter 5 is another example of the massive expansion of codes in ICD-10. I have highlighted some changes and included tips that I think are important to know for coding these conditions.

See below how the codes in this chapter are no longer grouped by psychotic, non-psychotic disorders, or mental retardation.

CODE COMPARISON

I-9

I-10

Psychoses290-299Mental Disorders due to Known Physiological ConditionsF01-F09
  Mental and Behavioral Disorders due to Psychoactive Substance UseF10-F19
  Schizophrenia, Schizotypal, Delusional, and Other Non-Mood Psychotic DisordersF20-F29
Neurotic Disorders, Personality Disorders, and Other Nonpsychotic Mental Disorders300-316Mood [affective] DisordersF30-F39
  Anxiety, Dissociative, Stress-Related, Somatoform and Other Nonpsychotic Mental DisordersF40-F48
  Behavioral Syndromes Associated with Physiological Disturbances and Physical FactorsF50-F59
  Disorders of Adult Personality and BehaviorF60-F69
Intellectual Disabilities317-319Intellectual DisabilitiesF70-F79
  F80-F89 Pervasive and Specific Developmental Disorders 
  Behavioral and Emotional Disorders with Onset Usually Occurring in Childhood and AdolescenceF90-F98
  Unspecified Mental DisorderF99

‍NOTE FROM ICD-10-CM CODER TRAINING MANUAL 2014

I-9

I-10

Tobacco Use Disorder (305.1)Exposure to environmental tobacco smoke (Z77.22)
 Exposure to tobacco smoke in the perinatal period (P96.81)
History of Tobacco Use (V15.82)History of tobacco use (Z87.91)
 Occupational exposure to environmental tobacco smoke (Z57.31)
 Tobacco dependence (F17.-)
 Tobacco use (Z72.0)

Many title changes for categories and subcategories were made in Chapter 5. Such as:Bipolar 1 Disorder, Single Manic Episode (296.0x) = Manic Episode (F30.xx)

Many changes were made due to outdated terminology. Examples can be seen in the accompanying table.

 

 

DID YOU KNOW?

DRG Shift

The CMS ICD-10 website contains information on the ICD-10 MS-DRG Conversion Project. An article from CMS, “Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments”, lists the top 10 MS-DRGs that shift to another DRG when re-coded with ICD-10. DRG 885, Psychoses is on that list. Currently, ICD-9 cases that have 296.20, Major Depression, Single Episode, Unspecified sequenced as the principal diagnosis will group to DRG 885, Psychoses. Under ICD-10, this same diagnosis is assigned to F32.9 (also includes Depression NOS) which groups the case to DRG 881, Depressive Neuroses, a lower-weighted DRG. Interestingly, many hospitals in Alabama have DRG 885 listed in their top 10 diagnoses each year. It would be a good idea to see how this change will impact your facility.

A large classification change was made to the drug and alcohol abuse/dependence codes.

  • There are codes to denote alcohol and drug “use”.
  • No longer identify “Continuous” and “Episodic” in I-10
  • Can code Blood Alcohol Levels as an additional code, if applicable:
    Y90.0, Evidence of alcohol involvement determined by blood alcohol level

Chapter 5 Guidelines

  • Physician documentation of a history of drug or alcohol dependence is coded as “in remission”.
  • For psychoactive substance use, abuse and dependence:

TIP

When documentation refers to use, abuse and dependence of the same substance only assign one code based on following hierarchy:

  • If use and abuse documented, assign abuse code
  • If abuse and dependence documented, assign dependence code
  • If use, abuse and dependence are documented, assign dependence code
  • If use and dependence are documented, assign dependence code

 

The codes in Chapter 5 parallel the codes in DSM-IV TR (Diagnostic and Statistical Manual of Mental Disorders-4 Text Revision) in most cases….from the ICD-10-CM Coder Training Manual, 2014 Instructor’s Edition. Psychiatrists tend to document these conditions as they are listed in the codebooks, which can make mental health coding a little easier. In addition, I hope all of the information provided to you in the I-10 Corner has helped make your job a little easier.

Article Author: Anita Meyers, RHIT, CCS
Anita Meyers, RHIT, CCS, is an Inpatient Coding Professional at Medical Management Plus. Anita has over twenty-six years of experience in inpatient and outpatient coding including 17 years of work at AQAF reviewing inpatient and outpatient records from Alabama hospitals. In addition to reviewing records she was the team leader in Beneficiary Services where she participated in case review activities, received and processed beneficiary complaints and handled fee-for-service denials for home health, hospice and skilled nursing facility services. Prior to joining the MMP team, Anita left AQAF to become an inpatient contract coder and worked at various hospitals in central Alabama. In her current position, Anita is an integral part of the Inpatient Services at Medical Management Plus.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.