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Coding Mental and Behavioral Disorders in ICD-10-CM

By Sarah Serling
May 10, 2012

Coding mental and behavioral disorders in ICD-9 can be challenging, so many coders are wondering how much more challenging it will be with the increased specificity available in ICD-10. ICD-10-CM doesn’t only include much greater detail, but more categories and more codes as well.

A mental disorder is a change in how a person feels (mood), acts (behavior) or thinks or perceives things, often associated with distress and impaired functioning. Examples include mood disorders such as depression, psychotic and delusional conditions, disorders caused by substance abuse, as well as behavioral and personality disorders.

Codes for Mental and Behavioral Disorders are located in Chapter 5 in both ICD-9-CM and ICD-10-CM, but some conditions are classified differently and the clinical terminology is also different. There is much greater detail in ICD-10-CM and more categories and codes as well. For example in ICD-10-CM, the codes for schizophrenia and delusional disorders include new categories—schizotypal disorder and undifferentiated schizophrenia. The organization of the categories is also different, although the broad categories of disorders are similar, such as mental or behavioral disorders with an organic origin, psychotic and non-psychotic disorders, intellectual disabilities and personality disorders.

Some of the names and definitions of disorders have also been updated in ICD-10-CM to reflect more current clinical terminology and standardization of the terms used to diagnosis mental, behavioral and substance use disorders. The American Psychiatric Association (publishers of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV) and the Centers for Disease Control and Prevention worked together to better align the DSM-IV and the Mental Disorders classification in ICD-10-CM.

Commonly used terms such as “substance abuse” or “substance dependence” are separate conditions in ICD-10-CM, so “abuse” and “dependence” are not interchangeable. The term "disorder" is used in the classification rather than "disease" and "illness". The classification also includes a terminology note regarding clarifying that “disorder" describes a clinically recognizable set of symptoms or behavior associated, in most cases, with interference with personal function and distress.

One notable difference involves substance use, abuse and dependence. These disorders not only include updated terminology, they are also classified and coded differently in ICD-10-CM. Alcohol dependence, drug dependence, and non-dependent abuse of drugs are classified to three different categories and ICD-10-CM includes more combination codes for alcohol and drug use and related conditions (hallucinations, withdrawal, etc.). The ICD-10-CM codes identify the aspects of use (withdrawal state), the effects (abuse and dependence) and the manifestations (alcohol abuse with alcohol-induced delirium). The substance involved is indicated in the second and third characters while the fourth and fifth characters specify the clinical state.

The guidelines for mental disorders diseases are also notably different ICD-10-CM—fortunately so for coders. No specific coding guidelines were ever developed for mental disorders in ICD-9-CM but detailed coding guidelines are provided for certain conditions classified in Chapter 5 of ICD-10-CM such as pain disorders with related psychological factors, mental and behavioral disorders due to psychoactive substance use and psychoactive substance use, abuse and dependence.

Other changes in ICD-10-CM involve sequencing instructions. In coding intellectual disability for example, the classification directs the user to code any associated physical or developmental disorder first rather than as additional codes.

One thing hasn’t changed however, the need for thorough documentation of all psychiatric disorders. Mental and behavioral disorders require detailed information on the acuity and etiology of the disease as well as any associated manifestations or complications—whether you’re using ICD-9 or ICD-10.


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