Nicohwilliam
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ICD-10-CMtrainingBehavioralHealth1.pptxICD-10-CM Compliance date is
October 1st 2015
Payers will only accept claims with ICD-10 codes with dates of service (or dates of discharge) on or after October 1st, 2015. Payers will deny claims with invalid codes based on date of service or discharge. ICD-9 codes will be accepted on claims with dates of service (or dates of discharge) through September 30th, 2015.
The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Act (HIPAA). Please note, the change to ICD-10 does not affect CPT or HCPCS level II coding for outpatient procedures and physician services.
Major Differences Between
ICD-9-CM & ICD-10-CM
Comparison of ICD-9-CM
& ICD-10-CM
ICD-9-CM Code
A - Category of code
B - Etiology, anatomical site, and manifestation
XXX.XX
A B
ICD-10-CM Code
A - Category of code
B - Etiology, anatomical site, and/or severity
C - Extension
7th character for obstetrics, injuries, and external causes of injury
XXX.XXXX
A B C
Examples of ICD-9-CM vs
& ICD-10-CM
| Description | ICD-9 code | ICD-10 code |
| Chronic motor or vocal tic disorder | 307.22 | F95.1 |
| Psychotic disorder with delusions | 293.81 | F06.2 |
| Mood disorder due to known physiological condition unspecified | 293.83 | F06.30 |
| Unspecified schizophrenia unspecified | 295.90 | F20.9 |
| Schizoaffective disorder, unspecified | 295.70 | F25.9 |
Let’s Review some ICD-10-CM
Psychiatric Conditions
DSM-V
Psychiatrists generally state diagnoses in accordance with the nomenclature used in the Diagnostic and Statistical Manual of Mental Disorders.
Most of these codes are the same as those used in ICD-10-CM, but the terminology may differ.
Actual coding assignments are made according to the classifications in ICD-10-CM.
Major Difference between DSM-V
and ICD-10
The Substance Use Section. While the DSM-5 eliminates the distinction between chemical abuse and dependence, the ICD-10 retains the categories of use, abuse, and dependence.
There are significantly more substance use diagnoses in the ICD-10 than there are in the DSM-5.
Because diagnoses in the DSM-5 have numerous possible iterations in the ICD-10, clinicians expecting a one-to-one code match need to be aware this is not the case.
ICD-10 Challenges
The number of actual diagnoses in each category has jumped significantly in the ICD-10 coding system
Another concern is that a single diagnosis code may represent very different conditions, ultimately necessitating more detailed clinician documentation
Improving clinical documentation requirements will be important for regulatory and auditing purposes. Given the inherent differences in the DSM-5 versus the ICD-10, decisions will need to be made about coding, diagnosing, terminology, and clinical documentation.
Crosswalks
In order to help providers arrive at the correct diagnosis in the ICD-10, “crosswalks” have been developed to help bridge the translation between the DSM and ICD.
Crosswalks typically map between the DSM and the ICD-10 codes to enable the clinician to pick the right code for billing purposes.
However, simply cross-walking between DSM-5 to the corresponding ICD-10 code will not produce an accurate code number.
The ICD-10 is more specific and contains many more diagnoses in the behavioral health section than the DSM-5 contains.
The code on the left is an ICD-9 code. The code on the right is an ICD-10 code. Beginning Oct. 1, 2015, you will need to use the code on the right.
Here is an excerpt from a page of
DSM-5 for post traumatic stress disorder
Where do you find the ICD-10
codes in DSM-5?
How do you code disorders that
now have multiple coding options?
Below is an illustration taken from the DSM-5.
The code on the left is an ICD-9 code. The code on the right is an ICD-10 code. Beginning Oct. 1, 2015, you will need to use the code on the right.
Organic Brain Syndrome
Since organic brain syndrome is used to describe a decrease in mental function due to a medical disease other than a psychiatric condition, it is coded to F09, Unspecified mental disorder due to known physiological condition.
The underlying physiological condition should be coded first
Altered Mental State
An alteration in level of consciousness not associated with delirium or another identified condition, is classified to category R40.
Mental Disorders Due to Known Physiological Conditions—F01-F09
Conditions reported in this ICD-10 code range include (when documented):
Dementia
Amnestic disorder due to known physiological condition
Delirium due to known physiological condition
Personality and behavioral disorders due to known physiological condition
Categories F01 – F09
This category reports mental disorders due to known physiological conditions grouped together on the basis of having a demonstrable etiology in cerebral disease, brain injury or other insult leading to cerebral dysfunction.
The cerebral dysfunction may be reported as either a primary or secondary diagnosis.
Primary Cerebral dysfunction
Primary cerebral dysfunction includes diseases, injuries and insults affecting the brain directly and selectively.
17
Secondary Cerebral Dysfunction
Secondary cerebral dysfunction includes systemic diseases and disorders which attack the brain only as one of the multiple organs or body systems involved.
ICD10 and Instructional Notes
You will encounter “instructional notes” intended to guide you to documentation which needs to be evident in the record to report the underlying physiological condition.
Example
Vascular dementia has an instructional note to code first the underlying physiological condition or sequelae of cerebrovascular disease.
An alteration in level of consciousness not associated with delirium or another identified condition is classified to category R40.
Category R40 in Chapter 18 of ICD-10-CM is further subdivided to indicate whether it is identified as somnolence, stupor, coma, persistent vegetative state or transient alteration of awareness.
Recording the Altered Mental
State ICD10 Category R40
An altered mental status or change in mental status of unknown etiology is coded to R41.82 “Altered mental status, unspecified”.
If the condition causing the change in mental status is known (and documented), do not assign code R41.82 – code the condition instead – if it recorded in the patient’s chart.
Unknown Etiology
Schizophrenic Disorders
Schizophrenic disorders are classified in ICD-10-CM in category F20 – with a 4th character indicating the type of schizophrenia
4th Character Options to Specify Schizophrenia
F20.0 Paranoid Schizophrenia
F20.1 Disorganized Schizophrenia
F20.2 Catatonic Schizophrenia
F20.3 Undifferentiated Schizophrenia
F20.5 Residual Schizophrenia
F20.8 Other
F20.81 Schizophrenia disorder
F20.89 Other Schizophrenia
F20.9 Schizophrenia unspecified
Affective Disorders
Major depressive disorder, bipolar disorders and anxiety disorders are classified under categories F30-F39
We need to code 4th & 5th characters!
Categories F32 and F33 report Major depressive disorders and are subdivided to provide information about the current severity of the disorder – such as mild, moderate, severe, etc.
Bipolar Affective Disorders
Bipolar affective diseases are divided into various types according to the documented symptoms displayed.
ICD-10-CM classifies bipolar disorders according to four categories
F30 Manic episode
F31 Bipolar disorder
F34 Persistent mood disorders
F39 Unspecified mood disorder
Anxiety, Dissociative, Stress-Related, Somatoform, and Other Nonpsychotic Mental Disorders—F40-F48
Diseases documented can be reported in ICD-10 include:
Phobic anxiety and anxiety disorders
Obsessive-compulsive disorders
Reaction to severe stress and adjustment
Dissociative conversion disorders
Somatoform disorders
Other nonpsychotic mental disorders
Behavioral Syndromes Associated with
Physiological Disturbances and Physical
Factors - F50-F59
The following disorders are reported here:
Eating disorders
Sleeping disorders
Sexual dysfunction not due to a substance or known physiological condition
Abuse of nonpsychoactive substances
Disorders of Adult Personality and Behavior— F60-F69
Categories reported here include:
Specific personality disorders—F60
Impulse disorders—F63
Gender identity disorders—F64
Paraphilias and sexual disorders—F65-F66
Other and unspecified disorders of adult personality and behavior—F68-F69
Mental Intellectual Disabilities— F70-F79
This block of codes reports mental Intellectual Disabilities according to severity (when documented):
Mild Intellectual Disabilities F70
Moderate Intellectual Disabilities—F71
Severe Intellectual Disabilities—F72
Profound Intellectual Disabilities—F73
Other and Unspecified Mental Intellectual Disabilities—F78-F79
Pervasive and Specific Developmental Disorders— F80-F89
This block of codes reports specific developmental disorders of:
Speech and language—F80
Scholastic skills—F81
Motor function—F82
Pervasive developmental disorders—F84
Other and unspecified disorders of psychological development—F88-F89
Behavioral and Emotional Disorders with
Onset Usually Occurring in Childhood and
Adolescence— F90-F98
This block of codes reports disorders with onset usually in childhood and adolescence but these codes may be used regardless of the age of the patient.
Code Range F90-F98 These categories report:
Attention-deficit hyperactivity disorders
Conduct disorders
Emotional disorders with onset specific to childhood
Disorders of social functioning with onset specific to childhood and adolescence
Tic disorders
Other behavioral and emotional disorders
Mental and Behavioral Disorders due
to Psychoactive Substance Use— F10-F19
These categories report mental disorders related to excessive use of substances.
Abuse is defined as taking alcohol/drugs to excess.
Dependence is defined as the chronic use of alcohol/drugs creating a dependence.
Alcohol-related disorders—F10
Opioid-related disorders—F11
Cannabis-related disorders—F12
Sedative-, hypnotic-, or anxiolytic-related disorders—F13
Cocaine-related disorders—F14
Other stimulant-related disorders—F15
Hallucinogen-related disorders—F16
Nicotine dependence—F17
Inhalant-related disorders—F18
Other psychoactive substance-related disorders—F19
ICD-10-CM Guidelines
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.
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:
If both use and abuse are documented, assign only the code for abuse
If both abuse and dependence are documented, assign only the code for dependence
If use, abuse and dependence are all documented, assign only the code for dependence
If both use and dependence are documented, assign only the code for dependence
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
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.
Pain disorders related to
psychological factors
Assign code F45.41, for pain that is exclusively related to psychological disorders.
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.
General Equivalence Mappings
(GEMs)
The Centers for Medicare and Medicaid (CMS) and the Centers for Disease Control and prevention (CDC) created GEMs to ensure consistent national data when the U.S. adopts ICD-10.
The GEMs will act as a translation dictionary to bridge the “language gap” between the two code sets and can be used to map an ICD-9 code to an ICD-10 code and vice versa.
Purpose of GEMs
Designed to give all sectors of the healthcare industry that use coded data the tools to:
Convert large databases and test system applications
Link data in long-term clinical studies
Develop application-specific mappings
Analyze data collected before and after the transition to ICD-10-CM
Not a Substitute for Coding
The GEMs should not be used as a substitute for learning how to use the ICD-10-CM code sets.
“GEMs are not a substitute for learning ICD-10-CM coding. They’ll help you convert large data sets.”
Mapping simply links concepts in the two code sets, without consideration of context of specific patient information, whereas coding involves assigning the most appropriate code based on documentation and applicable coding guidelines.
ICD-10-CMS Resources
ICD-10-CM Official Guidelines for Coding and Reporting FY 2016
https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2016-ICD-10-CM-Guidelines.pdf
Free lists of codes and ICD-9/ICD-10 mappings are available from CMS
https://www.cms.gov/Medicare/Coding/ICD10/2016-ICD-10-CM-and-GEMs.html
