Although mental health providers may use the DSM V for documentation and diagnostic purposes (it came out earlier this year in anticipation of ICD-10-CM), they must continue to translate DSM codes back to ICD-9-CM before billing. This will change as of October 1, 2015 when DMS V codes must map to ICD-10-CM, which includes several notable changes. Chandra Stephenson, CPC, CPC-H, CPCO, CPMA, CCS, CPC-I, CANPC, CEMC, CFPC, CGSC, CIMC, COSC, Indianapolis-based consultant and member of the American Academy of Professional Coders National Advisory Board discusses four important changes.
- Mental and behavioral disorders due to psychoactive substance use (F10-F19). Although ICD-9-CM doesn’t distinguish between use, abuse and dependence, ICD-10-CM does.
Many of the codes in this section also specify complications such as mood disorders, delusions, delirium, perceptual disturbances, and more.The ICD-10-CM guidelines have also been expanded to include a hierarchy for reporting purposes. Providers can only submit one code per substance (e.g., alcohol, opioid, cannabis, etc.). This hierarchy states the following:
- If the patient uses and abuses the same substance, assign only the code for abuse.
- If the patient abuses and is dependent the same substance, assign only the code for the dependence.
- If the patient uses, abuses, and is dependent the same substance, assign only the code for the dependence.
- If the patient uses and is dependent on the same substance, assign only the code for the dependence.Mental health providers must clearly document the association of the psychoactive substance with the patient’s mental or behavioral disorder.
- Pain disorders related to psychological factors (F45.4-). The ICD-10-CM guidelines have been expanded to include information related to codes F45.41 (pain disorder exclusively related to psychological factors) and F45.42 (pain disorder with related psychological factors). Although these two codes seem very similar, providers should note the following:
- Code F45.41 denotes purely psychological pain that is not supported by any medical condition.
- Code F45.42 denotes a legitimate medical pain with a psychological component. When reporting this code, providers should also report the associated acute or chronic pain (G89.-). Note that pain NOS is reported with R52.
- Attention deficit hyperactive disorder (ADHD) (F90.-). ICD-10-CM has been expanded to include the specific type of ADHD (i.e., predominantly inattentive, predominantly hyperactive, or combined). This code expansion, like many others, will be important in terms of research and treatment.
- Anorexia. ICD-10-CM includes separate codes for anorexia nervosa, unspecified (F50.00), anorexia nervosa, restricting type (F50.01), and anorexia nervosa, binge eating/purging type (F50.02). In ICD-9-CM, anorexia nervosa only had one code (307.1).
Strategies for Success
Mental health providers should review all of ICD-10-CM Chapter 5 (mental, behavioral, and neurodevelopmental disorders) to ensure compliant coding. As with many specialties, mental health diagnoses have expanded and/or include revised code descriptions. Specificity is the key to success.
For more tools and resources, download the free ICD-10 for Mental Health eBook or visit the ICD-10 Resource Center.