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Examining ICD-10-CM Codes for Mental, Behavioral and Neurodevelopmental Disorders – Part 3

In accordance with grouping disorders with a common theme together, affective disorders have been reclassified in ICD-10-CM. There are several mental disorders and behavioral syndromes directly caused by physiological dysfunction and hormonal imbalances. Some of these are nonorganic sleep disorders, eating disorders, and sexual dysfunctions, and in ICD-10-CM they are classified together and described in greater detail than in ICD-9-CM.

ICD-10-CM has included terminology in regard to the term “disorder” which will be used in the classification in lieu of the current terms “disease” or “illness.” According to Contexo Media’sBest Practices for ICD-10-CM Documentation and Compliance, “disorder” is described as a “clinically recognizable set of symptoms or behaviors which are, in most cases, associated with interference with personal function and distress.”

Organic mental or behavioral disorders are caused by a physiological condition such as disease or injury; therefore, the codes in this section will require the documentation of the underlying physiological condition. In ICD-10-CM, the codes for eating disorders are not assigned when the conditions are present due to a mental disorder classified elsewhere or are of organic origin.

Dementia is the manifestation of many diseases, the most prevalent being Alzheimer’s disease. In ICD-10-CM, physicians will be required to document the specific type of dementia and further include whether the dementia is related to other conditions. Additionally, if dementia has associated behavioral disturbances, these will need to be clearly documented as well. A prime example is when Alzheimer’s disease may also be associated with delirium or wandering.

331.0 Alzheimer’s disease

294.11 Dementia in conditions classified elsewhere with behavioral disturbance

V40.31 Wandering in conditions classified elsewhere

G30.9 Alzheimer’s disease, unspecified

F02.81 Dementia in diseases classified elsewhere, with behavioral disturbance

Z91.83 Wandering in diseases classified elsewhere

Consistent with what we see currently, mental disorders can be mild, moderate, or severe, in which case they interfere with the normal functioning of the patient. In ICD-10-CM it is important to document and code in detail for the severity of mental illnesses like schizophrenia, bipolar disorder, and severe forms of depression. Look at the example below to get a clearer picture of what this looks like in the code descriptions.

It is important to recognize that the documentation will require coders to identify more granular aspects of the mental disorder from the physician’s documentation. This means that clinical documentation improvement is crucial in ICD-10-CM, in order that the diagnoses are coded with the greatest specificity available.

As we know, the unspecified codes are not recommended to be used in place of more detailed documentation. The physicians will need training now so that they can begin to identify these particular aspects of the disorders in the documentation.

In cases where that specificity is not provided, the coder must first query the physician for that information. Since “they don’t know what they don’t know,” coders will need to educate and train medical providers on the documentation needed. Remember to offer provider training in small bits and with respect for their time.

F31.1 Bipolar disorder, current episode manic without psychotic features

F31.10 Bipolar disorder, current episode manic without psychotic features, Unspecified

F31.11 Bipolar disorder, current episode manic without psychotic features, Mild

F31.12 Bipolar disorder, current episode manic without psychotic features, Moderate

F31.13 Bipolar disorder, current episode manic without psychotic features, Severe

Continue to follow this series as we dig deep into the ICD-10-CM, Chapter 5 – Mental, Behavioral, and Neurodevelopmental Disorders.

For more ICD-10 articles, please visit our ICD-10 Updates page.

— Compiled by former CIPROMS ICD-10 Coordinator, Angela Hickman, CPC, CEDC, AHIMA-Approved ICD-10 CM/PCS Trainer, AHIMA Ambassador. All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com.


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