Mental and Behavioral Disorders 1

Mental, Behavioral and Neurodevelopment Disorders (F01- F99)  Codes in this chapter include disorders of psychosocial development, but exclude symptoms, signs and clinical laboratory findings (R00-R99) 2

I.C.5.a Pain Disorders Related to Psychological Factors  Assign code F45.41for pain that is exclusively related to psychological disorders.  As indicated by the ‘Excludes 1’ note under category G89, a code from category G89 (pain, not elsewhere classified) should not be assigned with code F

I.C.5.a. Pain disorders related to psychological factors  Code F45.42, pain disorders with related psychological factors, should be used with a codes from category G89, pain not elsewhere classified, if there is documentation of a psychological component for patient with acute or chronic pain 4

I.C.5.b.1. Codes F10-F19 in Remission  The appropriate codes for “in remission” are assigned only on the basis of provider documentation 5

Note  ICD-10-CM does not provide separate "history" codes for alcohol and drug abuse. These conditions are identified as "in remission" in ICD-10-CM.  Example: ●F10.21 Alcohol dependence, in remission 6

I.C.5.b.2 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 7

I.C.5.b.2 Psychoactive Substance use, Abuse and Dependence -2  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 8

I.C.5.3 Psychoactive Substance Use  Codes for psychoactive substance use should only be assigned based on provider documentation and when they meet the definition of a reportable diagnosis or additional diagnosis  Codes are to be used only when the psychoactive substance use is associated with a mental or behavioral disorder and such relationship is documented by the provider 9

Dementia Coding  F01 – Vascular dementia ●Vascular dementia as a result of infarction of the brain due to vascular disease, including hypertensive cerebrovascular disease. 10

F01 – Vascular Dementia  *code first the underlying physiological condition or sequelae of cerebrovascular disease  F01.50 Vascular dementia without behavioral disturbance  F01.51 Vascular dementia with behavioral disturbance (aggressive, combative, violent) 11

F02 – Dementia In Other Diseases Classified Elsewhere  *code first the underlying physiological condition, such as: ●Alzheimer’s (G30.-) ●Multiple sclerosis (G35) ●Parkinson’s disease (G20)  Excludes 1 note: dementia with Parkinsonism (G31.83)  F02.80 Dementia without behavioral disturbance  F02.81 Dementia with behavioral disturbance 12

F03 – Unspecified Dementia  Excludes 1 note: senility NOS (R41.81)  Excludes 2 note: senile dementia with delirium or acute confusional state (F05)  F03.90 Unspecified dementia without behavioral disturbance ●Dementia NOS  F03.91 Unspecified dementia with behavioral disturbance (aggressive, combative, violent) ●*use additional code to identify wandering in unspecified dementia (Z91.83) 13

F31 – Bipolar Disorder  Bipolar disorder, severe, now with codes for with or without psychotic features 14

Major Depressive Disorder  F32 Major depressive disorder, single episode  F33 Major depressive disorder, recurrent *if documented as severe, now with codes for with or without psychotic features 15

Q & A Chapter 5 – Mental And Behavioral Disorders (F01-F99) 16

Exercise #1  Code the following: ●Alcohol abuse with intoxication 17

Answer #1  Rationale: ●Does not specify the severity of alcohol use as previously seen in ICD-9-CM. If alcohol dependence was documented, the coding would go to F F10.129Abuse, alcohol (non-dependent), with, intoxication

Exercise #2  This 52-year-old male resident of the nursing facility has early onset Alzheimer’s disease. The dementia causes him to wander off. Assign the correct diagnostic code(s). 19

Answer #2 20 G30.0 F02.8 Disease, diseased, Alzheimer’s, F02.8 early onset, with behavioral disturbance Z91.83Wandering, in diseases classified elsewhere

Answer #2 -2  Rationale: ●Must have physician documentation of “early onset” Alzheimer’s to code this. ●See code first note under F02. to code first the underlying physiological condition, such as… ●At code F02.81, the note states to use additional code, if applicable, to identify wandering in dementia in conditions classified elsewhere (Z91.83) 21

Exercise #3  Resident had progressing dementia resulting from Parkinson’s disease and he realized that it was getting more difficult to remain in his own home, so he agreed to admission. Assign the correct diagnostic code(s). 22

Answer #3 23 G20 F02.80 Dementia (degenerative) (primary) (old age) (persisting), in (due to) Parkinson’s disease  Rationale:  Parkinsonism is not synonymous with Parkinson’s disease. Parkinsonism dementia (G31.83) and dementia due to Parkinson’s disease (G20) describe different conditions.  Refer to Excludes 1 note under F02 for dementia with Parkinsonism (G31.83).

Exercise #4  Resident admitted recently to facility starts having symptoms of visual hallucinations, saying that “persons are trying to kill her”. Resident already has history of Major Depression, but had not exhibited any symptoms until now. Physician query was done to clarify diagnosis and MD stated “recurrent severe episodes of psychotic depression”. Assign the appropriate diagnostic code(s). 24

Answer #4 25 F33.3Disorder, depressive, recurrent, current episode, severe, with psychotic symptoms  Rationale:  Without physician clarification of residents’ major depression, you wouldn’t be able to include the “psychotic symptoms”.  Note: If looked up in index under depression, major, recurrent, index refers you to disorder, depressive, recurrent.