Transitioning to ICD-10 Behavioral Health

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1 Transitioning to ICD-10 Behavioral Health Jeri Leong, R.N., CPC, CPC-H, CPMA Healthcare Coding Consultants of Hawaii LLC 1

2 Course Objectives Review of new requirements to ICD-10-CM Identify the areas of similarities and differences between ICD-9-CM and ICD-10-CM Understand the relationship between DSM-5 and ICD-10-CM Prepare for your transition by learning how to crosswalk ICD-9 to ICD-10 Determine clinical documentation elements required for ICD-10 code assignment 2

3 ICD Background Information Published by WHO in 1990 U.S. last industrialized nation to implement ICD-10 Two parts: ICD-10-CM and ICD-10-PCS ICD-10-CM - Diagnosis 3 7 alpha/numeric characters ICD-10-PCS Inpatient Procedures 7 alpha/numeric characters 3

4 DSM-5 and ICD-10-CM ICD codes are used for billing purposes; they support CPT codes that describe various services DSM has been the industry standard for behavioral health however the codes are not acceptable for billing purposes DSM IV and ICD-9-CM closely paralleled each other and were simple to convert for billing purposes DSM-IV and/or DSM-V codes must be converted to ICD- 10-CM codes for claim submission DSM-V contains the information needed to assign HIPAAcompliant, valid ICD-10-CM codes for a psychiatric diagnosis 4

5 The increased specificity of ICD-10-CM will not always provide for an effective crosswalk from DSM-5 criteria For example, Schizoaffective Disorder (ICD ) now splits into two ICD-10 codes 5

6 ICD-10 Format Codes are alpha numeric All letters of the alphabet except U V codes are now Z codes E codes are now V,W,X,Y codes Second through seventh characters are a combination of letters and numbers Remember I is not a 1 6

7 ICD-10-CM vs. ICD-9 Code Structure ICD-10-CM Code Format ICD-9-CM Code Format Ex: Bipolar disorder, current episode manic without psychotic features, mild ICD-10: F31.11 ICD-9:

8 Placeholders ICD-10 utilizes a placeholder X The X is used as a fourth, fifth or sixth character placeholder to allow for future expansion 7 th character extender is used to designate episode of care 8

9 7 th Character Extenders Identifies episode of care for injuries Initial - Receiving active treatment Subsequent - Receiving routine care during healing or recovery (after active treatment) Sequela - Complications or conditions arising as result of a condition 9

10 Example Placeholder and 7 th Character Extender Poisoning by, adverse effect of, and underdosing of other psychotropic drugs (intentional self-harm), initial encounter T43.8X2A 10

11 Mental, Behavioral and Neurodevelopmental Disorders 11

12 Mental Disorders due to Physiologic Conditions F01 Vascular Dementia F01.50 without behavioral disturbance F01.51 with behavioral disturbance F02 Dementia in other diseases classified elsewhere Code first the underlying physiologic condition, such as*: Alzheimers (G30.-) HIV disease (B20) Neurosyphilis (A52.17) F06 Mood disorders Further classified as those with various features, such as depressive or manic *not an all-inclusive list 12

13 Substance Abuse and Dependence F10 F19 Unique codes for alcohol and drug use, abuse, and dependence Continuous or episodic no longer classified Combination codes describe dependence, with manifestations such as delirium, hallucinations, dementia Codes are similar to ICD-9 in that they identify abuse, dependence and use Alcohol and various drugs are listed by category Blood alcohol level is listed as an additional code, if known (Y90.-) 13

14 Remission Selection of codes for in remission - categories F10-F19 requires the provider s clinical judgment The appropriate codes for in remission are assigned only on the basis of provider documentation 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 14

15 Nicotine Dependence ICD-9-CM = Tobacco Use Disorder -Current smoker Additional documentation required ICD-10-CM = F17- Terminology change to Nicotine dependence Type of nicotine (cigarette, chewing tobacco, cigar, pipe, etc.) Remission/Withdrawal/ Uncomplicated Use Z for History of nicotine dependence Use Z72.0 Tobacco Use (nondependent) 15

16 Schizophrenia, Schizotypal, Delusional and Other Nonmood Disorders F20 F25 represent various disorders Schizophrenia is further categorized by type, such as paranoid, disorganized, catatonic, undifferentiated and residual Psychotic disorders F23 and F24 Schizoaffective disorders fall into F25 and are further broken down into bipolar type and depressive type 16

17 Mood (affective) Disorders F30 represents the category for manic disorders In order to accurately assign an ICD-10 code, additional documentation will be required: with or without psychotic symptoms severity of illness (mild, moderate, severe) status of illness (partial or full remission) F31 represents bipolar disorders Additional documentation is required with or without psychotic features severity of current episode (mild, moderate, severe) status of episode (partial or full remission) 17

18 Mood Disorders - continued Major depressive disorders F32.- and F33.- Includes various types including endogenous, psychogenic, reactive, seasonal and others Similar to ICD-9, depressive disorders are categorized based on Episode (single or recurrent) Severity (mild, moderate severe) With and without psychotic features Status of illness (partial or full remission) Cyclothymic disorder F34.0 Dysthymic disorder F

19 Anxiety, Dissociative, Stress-related, Somatoform and Other Nonpsychotic Disorders Phobic anxiety disorders F40.- Additional documentation required for specific types of phobias, including animal type, natural environment, medical care, situational and other Agoraphobia is further categorized as with or without panic disorder Anxiety disorders are coded similarly to ICD-9, specific to generalized or mixed Post-traumatic stress disorder is subcategorized as F43.10 Unspecified F43.11 Acute F43.12 Chronic 19

20 Behavioral Syndromes Associated with Physiological Disturbances and Physical Factors Anorexia nervosa is split into three sub-categories and documentation must support the type for proper ICD-10 assignment F50.00 Unspecified F50.01 Restricting type F50.02 Binge eating/purging type Bulimia and other eating disorders (F50.2-F50.9)remain basically the same from the perspective of ICD assignment Sleep disorders (F51.-)require additional documentation elements to specify the type of insomnia Primary Adjustment Paradoxical Due to other mental disorder 20

21 Disorders of Adult Personality and Behavior Specific personality disorders are described in this section (F60.-) including Paranoid personality disorder F60.0 Schizoid personality disorder F60.1 Antisocial personality disorder F60.2 Borderline personality disorder F60.3 Histrionic personality disorder F60.4 Obsessive-compulsive personality disorder F60.5 Avoidant personality disorder F60.6 Dependent personality disorder F60.7 Narcissistic personality disorder F

22 Behavioral and Emotional Disorders with Onset Usually Occurring in Childhood or Adolescence Attention deficit hyperactivity disorders are categorized as: Predominantly inattentive type F90.0 Predominantly hyperactive type F90.1 Combined type F90.2 Conduct disorders are categorized as Confined to family context F91.0 Childhood onset type F91.1 Adolescent onset type F91.2 Oppositional defiant type F

23 Other Behavioral and Emotional Disorders with Onset Occurring in Childhood and Adolescence This category (F98.-) include various disorders such as Enuresis F98.0 Encopresis F98.1 Feeding disorders F98.2- Movement disorders F

24 Tools For Success 24

25 DSM and ICD-10 Determine how DSM-5/ICD-10 will impact your practice Review pre-authorizations, physician orders, billing software and other workflow tasks to ensure the seamless flow between DSM-4 and DSM-5 for clinical data capture DSM criteria will likely still be needed for pre-auth s and data reporting Review how DSM-5/ICD-10 will affect clinical documentation requirements and EHR templates For example, is the template still appropriate without the 5 axis paradigm 25

26 GEMs Translation What is GEMs? General Equivalence Mapping A mapping tool that attempts to include all valid relationships between the codes in ICD-9-CM and ICD- 10-CM An excellent training tool to be used to familiarize differences between ICD 9 and ICD-10 and may also be used to select the correct ICD-10 code. The mapping identifies one-to-one and one-to-many code relationships Only 5% of ICD-9 to ICD-10 are a direct match 26

27 27

28 In Summary DSM is clinical; ICD is for billing Many ICD-10 codes mirror ICD-9 in context, however there is expanded granularity for some categories Alcohol and substance dependence, abuse and use are more specific to the substance involved Clinical documentation is key for assignment of accurate ICD-10 codes If using EHR for lookups, utilize multiple words to narrow the search process 28

29 Questions? 29

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