No one body system is known to cause or be affected by mental disorders because the causes of mental illness are not always known. Stress can be a contributing factor in mental disorders. Psychological issues can and do affect one’s physical health.

Disease Conditions

Mental Disorders, found in Chapter 5 in the ICD-10-CM code book, are divided into the following categories:

CATEGORY	SECTION TITLES
F01-F09	Mental disorders due to known physiological conditions
F10-F19	Mental and behavioral disorders due to psychoactive substance abuse
F20-F29	Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders
F30-F39	Mood (affective) disorders
F40-F48	Anxiety, dissociative, stress-related, somatoform, and other nonpsychotic mental disorders
F50-F59	Behavioral syndromes associated with physiological disturbances and physical factors
F60-F69	Disorders of adult personality and behavior
F70-F79	Intellectual disabilities
F80-F89	Pervasive and specific developmental disorders
F90-F98	Behavioral and emotional disorders with onset usually occurring in childhood and adolescence
F99	Unspecified mental disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), is used by healthcare professionals to diagnose mental disorders on the basis of specific criteria. A multiaxial assessment system is used to assess clinical disorders, personality disorders and intellectual disabilities, medical conditions that may affect psychological condition, psychosocial and environmental factors (stressors such as homelessness or unemployment), and global assessment of functioning.

The DSM-IV-TR, or a text revision (TR), was published in 1996. It includes ICD-9-CM codes that should be assigned to all mental disorders and conditions. Many healthcare professionals use these ICD-9-CM codes within their documentation. These professionals may be taking the codes from the DSM-IV-TR, so it is always recommended to verify codes with the ICD-10-CM code book, to ensure accurate code assignment.

The DSM-5 is currently in development. A draft has been released for comment with an expected final publication in May 2013.

Mental Disorders due to Known Physiological Conditions (F01-F09)

Organic psychosis occurs as the result of deterioration in the brain. It is usually progressive and irreversible, as in senile dementia and Alzheimer’s disease. Organic brain damage may be produced by a variety of conditions, including arteriosclerosis, thrombi, metabolic conditions, infection, toxins, tumors, alcohol, and drugs. The onset and severity of damage depend on the cause. Organic brain syndrome (OBS) or disease is a general term that is used to describe the decrease in mental function caused by other physical disease(s).

Dementia

Dementia is a progressive deterioration of mental faculties that is characterized by impairment of memory and one or more cognitive impairments in areas such as language, reasoning, judgment, calculation, and problem-solving abilities. Cognitive impairment is a decline in mental activities associated with thinking, learning, and memory. Dementia can occur at any age but is more prevalent in the elderly. Disease processes that may be associated with dementia include the following:

Normal pressure hydrocephalus with dementia

Genetic or metabolic disease (e.g., thyroid)

Toxic or traumatic injury

Malignant disease and treatment

Although the term “senile” may be associated with those who are 65 years of age or older, it should not be assumed that because a patient is older than 65, a condition is due to senility. The physician must document within the health record the specific type of dementia. For many of the dementia codes, code assignment may depend on the presence of behavioral disturbances such as aggressiveness, combativeness, violence, or wandering off. There is a Z code, Z91.83, that should also be assigned to identify that the patient has a tendency to wander off.

Example

Patient is 70 years old and has dementia with delirium, F03.90, F05.

Example

Patient is 60 years old and has senile dementia, F03.90.

Exercise 13-1

Assign codes to the following conditions.

1. Pre-senile dementia with depression	_______________
2. Organic brain syndrome	_______________
3. Dementia due to neurosyphilis with behavioral disturbances	_______________
4. Dementia due to Pick’s disease	_______________
5. Multiple sclerosis with dementia	_______________
6. Postconcussion syndrome due to previous head trauma	_______________
7. AIDS-related dementia	_______________

Mental and Behavioral Disorders due to Psychoactive Substance Abuse (F10-F19)

Alcohol/Drug Dependence and Abuse and Associated Psychoses

Alcohol dependence, or alcoholism, is a chronic disease that is characterized by a strong compulsion to drink, increasing tolerance, the inability to stop drinking once the person has started, and physical dependence and withdrawal symptoms.

If alcohol dependence is associated with alcoholic psychosis, drug dependence or abuse, or physical complications, all diagnoses should be coded.

Drug dependence or addiction is similar to dependence on alcohol. It includes a compulsion to take the drug, increased tolerance, an inability to stop using, and physical withdrawal if the person does not have the drug.

It may be difficult for a healthcare provider to determine whether a patient is actually dependent on alcohol or drugs, so abuse codes tend to be used more often. It is possible that a patient is dependent on one drug and is abusing another drug or alcohol. Abuse and dependence codes of different substances can be used for the same patient.

Dependence is not limited to illegal substances and can occur with prescription drugs. Because drugs have generic and brand names, and since these are used interchangeably, it may be difficult to determine which category is assigned for a particular drug dependence. A drug reference book or an Internet search can be used to determine the generic name or category of the drug.

When a patient is admitted for a medical condition, they may have a comorbidity of alcohol dependence. Along with treating the medical condition, the patient’s alcohol dependence may need to be stabilized with drugs to prevent withdrawal. Because they are treating to prevent withdrawal does not mean that the patient is experiencing withdrawal and therefore withdrawal is not coded.

Example

Alcoholic gastritis with alcohol abuse, K29.20, F10.10. Upon verification of code K29.20 in the Tabular, there are instructions to use an additional code to identify alcohol abuse and dependence.

Drug or alcohol abuse indicates a problem with the substance that occurs without craving and physical dependence. However, it is likely that substance abuse can still cause problems with work, school, and home responsibilities and can interfere with relationships.

Particularly in the emergency room setting, physicians may document that the patient is a “drug seeker” or has “drug-seeking behavior.” Drug-seeking behavior is coded to F19.10, unspecified drug abuse, and Z76.5, person feigning illness.

Psychosis is an impairment in mental state by which one’s perception of reality becomes distorted. It may include visual or auditory hallucinations, paranoia or delusions, personality changes, and disorganized thinking. The use of alcohol or drugs could lead to alcohol- or drug-related psychosis. Psychotic episodes vary from person to person.

Alcohol withdrawal symptoms vary in severity from mild shakiness and sweating to the worst form, delirium tremens (DTs). Delirium tremens may involve severe mental or neurologic changes such as delirium and/or hallucinations. This is a life-threatening condition. People who have gone through withdrawal once are more likely to have withdrawal symptoms again when they stop drinking. Seizures are also a common form of withdrawal.

When a patient is admitted for withdrawal symptoms, the withdrawal code is assigned as the principal diagnosis. In the Alphabetic Index under the term “withdrawal state,” there is a cross reference to see also Dependence, drug by type, with withdrawal (Figure 13-1).

Example

Seizure due to alcohol withdrawal. Patient is an alcoholic who usually drinks every day but hasn’t had a drink in 2 days, F10.239, R56.9.

Example

Patient is being treated for withdrawal due to dependence on Valium, F13.239.

FIGURE 13-1 Cross reference for withdrawal.

Admissions to the hospital for drug psychosis are on the rise. A number of drugs can induce psychosis; cocaine and methamphetamine are the most common.

Example

Paranoia due to methamphetamine (meth). Patient is dependent on meth, F15.259.

When a patient is on a maintenance program for drug dependence, the appropriate code for drug dependence is assigned. For example, suboxone treatment is used to reduce withdrawl symptoms and cravings in people who are addicted to heroin or narcotics. It is not necessary to assign a Z code for long-term drug therapy.

Exercise 13-2

Assign codes to the following conditions.

1. Delirium tremens due to chronic alcoholism	_______________
2. Morphine-induced delirium (adverse effect)	_______________
3. Addiction to heroin and OxyContin	_______________
4. Cirrhosis of liver due to chronic alcoholism	_______________
5. Wernicke-Korsakoff syndrome; patient is an alcoholic who has been sober for 2 years	_______________
6. Acute alcohol intoxication with blood alcohol level of 200 mg/100 mL	_______________
7. Cocaine dependence in patient who abuses marijuana	_______________

Schizophrenia, Schizotypal, Delusional, and Other Non-mood Psychotic Disorders (F20-F29)

Schizophrenia

Schizophrenia is a disorder of the brain. A person with schizophrenia may have trouble differentiating between real and unreal experiences and may not demonstrate logical thinking, normal emotional responses to others, and appropriate behavior in social situations. A genetic component is associated with the disease, in that people who have family members with the disease are more likely to exhibit the disease themselves. Schizophrenia usually has its onset during young adulthood, and it affects men and women equally. Five types of schizophrenia have been identified:

Catatonic—withdrawn, in one’s own world

Paranoid—suspicious of others

Disorganized—disorganized thought process, unable to communicate coherently

Undifferentiated—mixed types of schizophrenia

Residual—has milder symptoms that come and go

Example

The patient has been in a chronic catatonic state of schizophrenia, F20.2.

Schizoaffective Disorders

Schizoaffective disorder is a condition in which a person experiences a combination of schizophrenia symptoms while exhibiting mood disorder symptoms, such as mania or depression. It can be difficult to differentiate a schizoaffective disorder from schizophrenia and from a mood disorder. Also, symptoms of schizoaffective disorder vary and may range from mild to severe.

Symptoms of schizoaffective disorder may include:

Depression