Coding spotlight: Providers’ guide to coding for behavioral health disorders

Please note, this communication applies to Anthem HealthKeepers Plus offered by HealthKeepers, Inc.

 

Behavioral health disorders are classified in Chapter 5 of the ICD-10-CM

 

Behavioral health disorders are commonly underreported on claims. Many Anthem HealthKeepers Plus members may have behavioral health disorders that are not properly managed. Health care providers can assist by taking detailed histories and coding behavioral health issues properly on claims. Below are the ICD-10-CM coding guidelines for behavioral health conditions.

 

When documenting behavioral disorders, the following descriptors apply:

 

• Type: Depressive, manic, or bipolar disorder.

 

• Episode: Single or recurrent.

 

• Status: Partial or full remission; identify most recent episode as manic, depressed, or mixed.

 

• Severity: Mild, moderate, severe, or with psychotic elements.

 

Schizophrenic related disorders

 

Schizophrenic related disorders are classified in category F20, with a forth character indicating the type of schizophrenia as follows:

 

Code	Description
F20.0	Paranoid schizophrenia
F20.1	Disorganized schizophrenia
F20.2	Catatonic schizophrenia
F20.3	Undifferentiated schizophrenia
F20.5	Residual schizophrenia
F20.8	Other schizophrenia This subcategory is further subdivided as follows: ·         F20.81 Schizophreniform disorder ·         F20.89 Other schizophrenia
F20.9	Schizophrenia, unspecified

 

Major depressive disorder (MDD)

 

Major depressive disorder (MDD) is classified in ICD-10-CM to categories:

 

• F32.- Major depressive disorder, single episode

 

• F33.- Major depressive disorder, recurrent

 

Categories F32 and F33 are further subdivided with fourth characters, and sometimes fifth characters, to provide information about the current severity of the disorders, as follows:

 

• 0 Mild

 

• 1 Moderate

 

• 2 Severe, without psychotic features

 

• 3 Severe with psychotic features

 

• 4 In remission

 

• 5 In full remission

 

• 8 Other

 

• 9 Unspecified

 

Fourth characters 1 through 8 are assigned only when provider documentation of severity is included in the medical record.

 

Manic episodes and bipolar disorders

 

The table below outlines the ICD-10-CM classification for bipolar disorders. Manic/mania also falls within this code category. The codes in these categories require fourth and/or fifth digits to identify the severity of the current episode and whether or not psychotic symptoms are involved.

 

Category	Description
F30.-	Manic episode (includes bipolar disorder, single manic episode, and mixed affective episode)	Select appropriate fourth and fifth digits to identify the severity of the current episode to indicate whether psychotic symptoms are involved
F31.-	Bipolar disorder (includes manic-depressive illness, manic-depressive psychosis, and manic-depressive reaction)	Select appropriate fourth and fifth digits to specify the severity of the current episode and whether the current episode is hypomanic, manic, depressed or mixed, and with or without psychotic features.
F34.-	Persistent mood [affective] disorders (includes cyclothymic disorder and dysthymic disorder)	Includes, cyclothymic, dysthymic, and other specified mood disorders.
F39	Unspecified mood [affective] disorder (includes affective psychosis not otherwise specified)	Include affective psychosis when not otherwise specified

 

Anxiety disorders

 

Anxiety disorders are classified in ICD-10-CM under the following categories:

 

• F40 Phobic anxiety disorders

 

• F41 Other anxiety disorders

 

• F42 Obsessive-compulsive disorder

 

Dissociative and conversion disorders

 

ICD-10-CM classifies dissociative and conversion disorders to category F44.

 

Dissociative disorders:

 

Code	Description
F44.0	Dissociative amnesia
F44.1	Dissociative fugue
F44.2	Dissociative stupor
F44.81	Dissociative identity disorder

 

Conversion disorders:

 

Code	Description
F44.4	Conversion disorder with motor symptom or deficit
F44.5	Conversion disorder with seizures or convulsions
F44.6	Conversion disorder with sensory symptom or deficit
F44.7	Conversion disorder with mixed symptom presentation

   

Behavioral syndromes associated with physiological disturbances and physical factors

 

Categories F50 through F59 grouping includes the following conditions:

Category/ code	Description
F50.0-	Eating disorders (such as anorexia nervosa and bulimia nervosa)
F51.-	Sleep disorders not due to a substance or known physiological condition
F52.-	Sexual dysfunction not due to a substance or known physiological condition
F53.-	Mental and behavioral disorders associated with the puerperium, not elsewhere classified
F54	Psychological and behavioral factors associated with disorders or diseases classified elsewhere
F55.-	Abuse of non-psychoactive substances
F59	Unspecified behavioral syndromes associated with physiological disturbances and physical factors

 

Disorders of adult personality and behavior

 

Categories F60 through F69 include disorders of adult personality and behavior:

Category code	Description
F60.0-	Specific personality disorders
F63.-	Impulse disorders
F64.-	Gender identity disorders
F65.-	Paraphilias
F66.-	Other sexual disorders
F68.-	Other disorders of adult personality and behavior

 

Psychosocial circumstances and encounters

 

ICD-10-CM provides codes for behaviors that have not yet been classified to behavioral disorders, but that may contribute to the need for further treatment or study. The table below shows some examples:

Code	Description
R41.0	Disorientation, unspecified
R41.82	Altered mental status, unspecified
R41.840	Attention and concentration deficit
R44.3	Hallucinations, unspecified
R45.83	Excessive crying of child, adolescent or adult
R45.84	Anhedonia
R45.86	Emotional liability
R45.87	Impulsiveness
R46.0	Very low level of personal hygiene
R46.2	Strange and inexplicable behavior
R46.81	Obsessive-compulsive behavior

 

For behavioral health disorders that resolve and do not require continued treatment, it is appropriate to report code Z86.59, Personal history of other mental and behavioral disorders.

 

If you have any questions about this communication, call Provider Services at 1‑800‑901‑0020 or Anthem CCC Plus Provider Services at 1‑855‑323‑4687.

 

Resources:

1. ICD-10-CM Expert for Physicians. The complete official code set. Optum360, LLC. 2019.

 

2. ICD-10-CM/PCS Coding. Theory and practice. 2019/2020 Edition. Elsevier.

 

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