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5 Chapter-Specific Coding Guidelines Presentation Taracharlestonaprnconference.com/Charleston...
Transcript of 5 Chapter-Specific Coding Guidelines Presentation Taracharlestonaprnconference.com/Charleston...
2/17/2014
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Chapter‐Specific Coding Guidelines
Chapter 5 – Mental, Behavioral, and Neurodevelopmental Disorders (F01‐
F99)
2 main sets of diagnostic classifications for Mental, Behavioral, and Neurodevelopmental Disorders
International Classification of Disease
ICDDiagnostic and Statistical Manual of Mental Disorders
DSM
Classification: ICD DSM
Developed by: World Health Organization (WHO)
American Psychiatric Association (APA)
Purpose: Official diagnostic coding system in the US used for reporting and identifying the reason for the visit
A provider’s guide used for identifying and determining a diagnosis
Composed of: Physical and mental disorders Only mental disorders
Content: List codes without including the diagnostic criteria for code selection
Contain the diagnostic criteria for code selection
Structure: Divided into 10 sections Divided into 16 chapters
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This chapter contains the following blocks:• F01‐F09 Mental disorders due to known physiological conditions• F10‐F19 Mental and behavioral disorders due to psychoactive
substance use• 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‐F99 Behavioral and emotional disorders with onset usually
occurring in childhood and adolescence
Pain disorders related to psychological factors
F45. 4‐ Pain disorders related to psychological factorsExcludes 1 pain NOS (R52)F45.41 Pain disorder exclusively related to
psychological factorsSomatoform pain disorder (persistent)
F45.42 Pain disorder with related psychological factors
Code also associated acute or chronic pain (G89.‐)
(*the Excludes 1 note under G89.‐ indicate that it should not be used with F45.41*)
Please notice the difference
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Mental and behavioral disorders due to psychoactive substance abuse
– Selection of remission requires the provider’s clinical judgment
– Assigned only based on the provider’s documentation
Remission
DSM‐V
In early remission
In sustained remission
ICD‐10“in
remission”
• Selection of “in remission” for codes F10‐F19 (…due to psychoactive substance use) is coded as ‐.21
Alcohol dependenceExcludes1: alcohol abuse (F10.1‐)
alcohol use, unspecified (F10.9‐)
Excludes2: toxic effect of alcohol (T51.0‐)
F10.20 Alcohol dependence, uncomplicated
F10.21 Alcohol dependence, in remission
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DependenceAbuse vs.Use vs.
A definite diagnosis of dependence should usually be made only if three or more of the following have been present together at some time during the previous year:
– A strong desire or sense of compulsion to take the substance;– Difficulties in controlling substance‐taking behavior in terms of its onset, termination, or levels of
use;– A physiological withdrawal state when substance use has ceased or have been reduced, as
evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or closely related) substance with the intention of relieving or avoiding withdrawal symptoms;
– Evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses (clear examples of this are found in alcohol‐ and opiate‐dependent individuals who may take daily doses sufficient to incapacitate or kill nontolerant users);
– Progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects;
– Persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to periods of heavy substance use, or drug‐related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm.
• The diagnosis requires that actual damage should have been caused to the mental or physical health of the user.
• Harmful patterns of use are often criticized by others and frequently associated with adverse social consequences of various kinds. The fact that a pattern of use or a particular substance is disapproved of by another person or by the culture, or may have led to socially negative consequences such as arrest or marital arguments is not in itself evidence of harmful use.
• Acute intoxication, or “hangover” is not in itself sufficient evidence of the damage to health required for coding harmful use.
• Harmful use should not be diagnosed if dependence syndrome, a psychotic disorder, or another specific form of drug‐ or alcohol‐related disorder is present.
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Abuse DependenceAlcohol Abuse Disorder
Severe
Moderate
Mild
• Presence of 6 or more symptoms
• Presence of 4‐5 symptoms
• Presence of 2‐3 symptoms
• Essential feature: Problematic pattern of alcohol use leads to clinically significant distress or impairment
• At least two of the following in a 12‐month period:1. Taken in larger amounts or over a longer period of time than intended2. Persistent desire or efforts to cut down or control use3. Much time taken obtaining using or recovering from substance4. Cravings or a strong desire or urge to use a substance (new criteria)5. Recurrent use resulting in failure to fulfill role obligation (work, school, or
home)6. Continued used despite social and interpersonal problems7. Social, occupational, or recreational activities reduced due to alcohol8. Recurrent use in hazardous situations9. Continued use despite physical or psychological problems due to substance10. Tolerance 11. Withdrawal
• Specifiers: Early remission, Sustained remission, and In controlled environment
• Severity: Mild, Moderate, or Severe
ICD‐10‐CM
• F10‐10 – Alcohol abuse, uncomplicated
• F10.20 – Alcohol dependence, uncomplicated
• F10.20 – Alcohol dependence, uncomplicated
DSM‐V
• F10.10 – Alcohol Use Disorder, Mild
• F10.20 – Alcohol Use Disorder, Moderate
• F10.20 – Alcohol Use Disorder, Severe
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Cannot be coded together…
Dependence
Abuse
Use
Use Abuse Abuse
Code asIf both are document
Abuse Dependence Dependence
If both are documentCode as
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Use Dependence Dependence
If both are documentCode as
Dependence
Use
Abuse
Dependence
Code as
If all three are document:
MENTAL, BEHAVIORAL AND NEURODEVELOPMENTAL DISORDERS (F01‐F99)
Additional Changes
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• Change in terminology...
Intellectual Disabilities (F70‐F79)Code first any associated physical or developmental disordersExcludes1: borderline intellectual functioning, IQ above 70 to 84 (R41.83)
F70 Mild intellectual disabilitiesIQ level 50‐55 to approximately 70Mild mental subnormalityF71 Moderate intellectual disabilitiesIQ level 35‐40 to 50‐55Moderate mental subnormalityF72 Severe intellectual disabilitiesIQ 20‐25 to 35‐40Severe mental subnormalityF73 Profound intellectual disabilitiesIQ level below 20‐25Profound mental subnormalityF78 Other intellectual disabilitiesF79 Unspecified intellectual disabilitiesMental deficiency NOSMental subnormality NOS
Previously known as Mental Retardation
ICD‐10‐CM
F84.0 Childhood autismInfantile autismInfantile psychosisKanner’s syndromeExcludes1: Asperger’s syndrome (F84.5)
F84.5 Asperger’s syndromeAsperger’s disorderAutistic psychopathySchizoid disorder of childhood
DSM‐V
• F84.0 Autism Spectrum Disorder (Encompasses autism disorder, Asperger’s disorder, and pervasive developmental disorder NOS)
Specifiers:With or without accompanying
intellectual impairmentWith or without accompanying language
impairmentAssociated with a known medical or
genetic condition or environmental factor
Associated with another neurodevelopmental, mental, or behavioral disorder
With catatonia
Coding Challenges
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Case:
A 26‐year‐old male was taken to the emergency department by the local sheriff after the patient became disruptive in a local nightclub. The patient tested positive for cocaine, and alcohol. The patient was diagnosed with alcohol abuse, which was uncomplicated, and cocaine abuse with cocaine‐induced mood disorder.
Diagnoses:• F10.120 – Alcohol abuse with intoxication, uncomplicated
• F14.14 – Cocaine abuse with cocaine‐induced mood disorder
• Y90.9 – Presence of alcohol in blood, level not specified
Patient is a 55‐year‐old female who lost her husband eight months ago in an industrial accident. She was released from the hospital three weeks ago due to suicide attempt. She is suffering from a moderate major depressive disorder, which is recurrent. At that time, the patient stated she no longer wished to live without her spouse. She has been monitored once per week since her release. Last visit, her medications were slightly changed. Patient states she is feeling better and her mood is improving. She has no current thoughts of suicide.
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Diagnosis:
• F33.1 – Major depressive disorder, recurrent, moderate
References• AMA ‐ The Complete Official Draft Code Set ICD‐10‐CM 2014
• AHIMA – ICD‐10‐CM Overview: Deciphering the Code http://campus.ahima.org/TopClass.dll?Conn‐PCnm9hqHvXopURNr‐CnTxT‐31630115‐Frame‐Setup‐IndFrame‐retrieve‐coursework‐H0ICD10OVER%5F13‐ContFrame‐Info‐Class‐28412596D0
• APA – Diagnostic and Statistical Manual of Mental Disorders Fifth Edition
• CMS 2014 ICD‐10‐CM and GEMs http://www.cms.gov/Medicare/Coding/ICD10/2014‐ICD‐10‐CM‐and‐GEMs.html
• Grider, D., Preparing for ICD‐10‐CM: Make the Transition Manageable
• Grider, D., Principles for ICD‐10‐CM Coding Workbook
• World Health Organization Website http://www.who.int/substance_abuse/terminology/definition2/en/