Mental, Behavioral, and Neurodevelopmental Disorders: (ICD-9-CM Chapter 5, Codes 290-319, and ICD-10-CM Chapter 5, Codes F01-F99)



Mental, Behavioral, and Neurodevelopmental Disorders


(ICD-9-CM Chapter 5, Codes 290-319, and ICD-10-CM Chapter 5, Codes F01-F99)



Learning Objectives



1. Apply and assign the correct ICD-9-CM and ICD-10-CM codes in accordance with Official Guidelines for Coding and Reporting


2. Identify major differences between ICD-9-CM and ICD-10-CM related to mental, behavioral, and neurodevelopmental disorders


3. Identify pertinent anatomy and physiology of mental, behavioral, and neurodevelopmental disorders


4. Identify various mental, behavioral, and neurodevelopmental disorders


5. Assign the correct V/Z codes and procedure codes related to mental, behavioral, and neurodevelopmental disorders


6. Identify common treatments and medications


7. Explain the importance of documentation in relation to MS-DRGs for reimbursement



Abbreviations/Acronyms






















ICD-10-CM Official Guidelines for Coding and Reporting


Please refer to the companion Evolve website for the most current guidelines.




5. Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01-F99)



a. Pain disorders related to psychological factors


    Assign code F45.41 for pain that is exclusively related to psychological disorders. As indicated by the Excludes 1 note under category G89, a code from category G89 should not be assigned with code F45.41


    Code F45.42, Pain disorders with related psychological factors, should be used with a code from category G89, Pain, not elsewhere classified, if there is documentation of a psychological component for a patient with acute or chronic pain.


    See Section 1.C.6. Pain


b. Mental and behavioral disorders due to psychoactive substance use



1) In Remission


    Selection of codes for “in remission” for categories F10-F19, Mental and behavioral disorders due to psychoactive substance use (categories F10-F19 with -.21) requires the provider’s clinical judgment. The appropriate codes for “in remission” are assigned only on the basis of provider documentation (as defined in the Official Guidelines for Coding and Reporting).


2) Psychoactive Substance Use, Abuse and Dependence


    When the provider documentation refers to use, abuse and dependence of the same substance (e.g. alcohol, opioid, cannabis, etc.), only one code should be assigned to identify the pattern of use based on the following hierarchy:


    



3) Psychoactive Substance Use


    As with all other diagnoses, the codes for psychoactive substance use (F10.9-, F11.9-, F12.9-, F13.9-, F14.9-, F15.9-, F16.9-) should only be assigned based on provider documentation and when they meet the definition of a reportable diagnosis (see Section III, Reporting Additional Diagnoses). The codes are to be used only when the psychoactive substance use is associated with a mental or behavioral disorder, and such a relationship is documented by the provider.


Apply General Coding Guidelines as found in Chapter 5 and the Procedural Guidelines as found in Chapter 7.


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 mental retardation, 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-9-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.






Disease Conditions


Mental Disorders (290-319), which is Chapter 5 in your ICD-9-CM code book, is divided into the following categories:




















CATEGORY SECTION TITLES
290-294 Organic Psychotic Conditions
295-299 Other Psychoses
300-316 Neurotic Disorders, Personality Disorders, and Other Nonpsychotic Mental Disorders
317-319 Intellectual Disabilities

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 and 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


Organic Psychotic Conditions


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:



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.



Example


Patient is 70 years old and has dementia, 294.20 (F03.90).



Example


Patient is 60 years old and has senile dementia, 290.0 (F30.90).



Alcohol/Drug Psychoses


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. Three codes are specific to alcohol withdrawal:













291.0 (F10.231) Alcohol withdrawal delirium
291.3 (F10.251) Alcohol withdrawal hallucinosis
291.81 (F10.239) Alcohol withdrawal

“Only one code should be assigned to describe alcohol withdrawal. Code 291.0 takes precedence over the other two codes, and 291.3 takes precedence over the 291.81 code,” according to Coding Clinic (1991:2Q:p11-12)1 (Figure 13-1). If a patient is experiencing symptoms of withdrawal, the alcohol dependence category 303 instructs the use of an additional code for alcoholic psychoses (withdrawal), drug dependence, and/or any physical complications related to alcohol (Figure 13-2). When a patient is admitted for withdrawal symptoms, the withdrawal code is assigned as the principal diagnosis.


image
Figure 13-1 Excludes note for alcohol withdrawal.

image
Figure 13-2 Use additional code for category 303.


Example


Seizure due to alcohol withdrawal. Patient is an alcoholic who usually drinks every day but hasn’t had a drink in 2 days, 291.81, 780.39, 303.91 (F10.239, R56.9).



Example


Wernicke-Korsakoff syndrome. Patient is an alcoholic who has not had a drink in 2 years, 291.1, 303.93 (F10.26, F10.21).


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, continuous use, 292.11, 304.41 (F15.259).



Exercise 13-1


Assign codes to the following conditions.


































 1. Delirium tremens due to chronic alcoholism, continuous _______________
 2. Pre-senile dementia with depression _______________
 3. Morphine-induced delirium (adverse effect) _______________
 4. Organic brain syndrome _______________
 5. Dementia due to neurosyphilis with behavioral disturbances _______________
 6. Dementia due to malnutrition _______________
 7. Normal pressure hydrocephalus with dementia _______________
 8. Creutzfeldt-Jacob disease with dementia with behavioral disturbance _______________
 9. AIDS-related dementia _______________
10. Binswanger’s disease _______________


Other Psychoses


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:




Example


The patient has been in a chronic catatonic state of schizophrenia, 295.22 (F20.2).



Mood Disorders


Mood disorders occur when a change in mood has been present for a prolonged time. The two most common mood disorders (affective disorders) are major depression and bipolar disorder (manic-depressive illness). Mood disorders can be triggered by a life event or by a chemical imbalance. The type of depression that is included in category 296 is different than depression, not otherwise specified (311). Bipolar disorder is characterized by mood swings. Onset of symptoms is most likely to occur in early adulthood. A person with bipolar disorder can have four main types of mood “episodes”:



Major depressive disorder is characterized by one or more major depressive episodes with a history of mania, hypomania, or mixed episodes. In major depression, more numerous symptoms of depression may be present, and usually, the symptoms are more severe. Major depression is most likely to occur in persons between the ages of 25 and 44; an episode may last from 6 to 9 months.



Example


The patient was diagnosed with major depressive disorder of moderate severity, single episode, 296.22 (F32.1).



Example


The patient is in a severe manic phase of bipolar I disorder, 296.43 (F31.13).



Exercise 13-2


Assign codes to the following conditions.



















1. Bipolar disorder, currently depressed _______________
2. Autism _______________
3. Major depressive disorder, recurrent _______________
4. Paranoid schizophrenia _______________
5. Delusional disorder _______________


Neurotic Disorders, Personality Disorders, and Other Nonpsychotic Mental Disorders


Anxiety Disorders


Following is a breakdown of the different types of anxiety disorders:


Related posts:

  1. Diseases of the Skin and Subcutaneous Tissue: (ICD-9-CM Chapter 12, Codes 680-709, and ICD-10-CM Chapter 12, Codes L00-L99)
  2. Diseases of the Blood and Blood-Forming Organs: (ICD-9-CM Chapter 4, Codes 280-289, and ICD-10-CM Chapter 3, Codes D50-D89)
  3. Diseases of the Circulatory System: (ICD-9-CM Chapter 7, Codes 390-459, and ICD-10-CM Chapter 9, Codes I00-I99)
  4. Introduction to ICD-10-PCS

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Jun 14, 2017 | Posted by in GENERAL SURGERY | Comments Off on Mental, Behavioral, and Neurodevelopmental Disorders: (ICD-9-CM Chapter 5, Codes 290-319, and ICD-10-CM Chapter 5, Codes F01-F99)

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