ATTACHMENT A. ICD-9-CM MENTAL DISORDERS DIAGNOSIS CODES AND DESCRIPTIONS Subject to Certification of Admission/Concurrent/Continued Stay Review

Transcription

1 ATTACHMENT A ICD-9-CM MENTAL DISORDERS DIAGNOSIS CODES AND DESCRIPTIONS Subject to Certification of Admission/Concurrent/Continued Stay Review This list contains principal diagnosis codes for psychiatric services Category of Service 21. General care hospitals that are not enrolled for COS 21 will continue to bill for a maximum of three days of emergency psychiatric care using COS 20. The description of codes noted in bold has changed based on ICD-9-CM coding guidelines effective Schizophrenic disorders Unspecified Subchronic Chronic Subchronic with acute exacerbation Chronic with acute exacerbation In remission Disorganized type unspecified Disorganized type subchronic Disorganized type chronic Disorganized type subchronic with acute exacerbation Disorganized type chronic with acute exacerbation Disorganized type in remission Catatonic type unspecified Catatonic type subchronic Catatonic type chronic Catatonic type subchronic with acute exacerbation Catatonic type chronic with acute exacerbation Catatonic type in remission Paranoid type unspecified Paranoid type subchronic Paranoid type chronic Paranoid type subchronic with acute exacerbation Paranoid type chronic with acute exacerbation Paranoid type in remission Schizophreniform disorder, unspecified Schizophreniform disorder, subchronic Schizophreniform disorder, chronic Schizophreniform disorder, subchronic with acute exacerbation Schizophreniform disorder, chronic with acute exacerbation Schizophreniform disorder, in remission Latent schizophrenia unspecified Attachment A - Page 1

2 Latent schizophrenia subchronic Latent schizophrenia chronic Latent schizophrenia subchronic with acute exacerbation Latent schizophrenia chronic with acute exacerbation Latent schizophrenia in remission Schizophrenic disorders, residual type, unspecified Schizophrenic disorders, residual type, subchronic Schizophrenic disorders, residual type, chronic Schizophrenic disorders, residual type, subchronic with acute exacerbation Schizophrenic disorders, residual type, chronic with acute exacerbation Schizophrenic disorders, residual type, in remission Schizoaffective disorder,unspecified Schizoaffective disorder, subchronic Schizoaffective disorder, chronic Schizoaffective disorder, subchronic with acute exacerbation Schizoaffective disorder, chronic with acute exacerbation Schizoaffective disorder, in remission Other specified types of schizophrenia unspecified Other specified types of schizophrenia subchronic Other specified types of schizophrenia chronic Other specified types of schizophrenia subchronic with acute exacerbation Other specified types of schizophrenia chronic with acute exacerbation Other specified types of schizophrenia in remission Unspecified Subchronic Chronic Subchronic with acute exacerbation Chronic with acute exacerbation In remission Bipolar I disorder, single manic episode, unspecified Bipolar I disorder, single manic episode, mild Bipolar I disorder, single manic episode, moderate Bipolar I disorder, single manic episode, severe, without mention of psychotic behavior Bipolar I disorder, single manic episode, severe, specified as with psychotic behavior Bipolar I disorder, single manic episode, in partial or unspecified remission Bipolar I disorder, single manic episode, in full remission Attachment A - Page 2

3 Manic disorder, recurrent episode unspecified Manic disorder, recurrent episode mild Manic disorder, recurrent episode moderate Manic disorder, recurrent episode severe, without mention of psychotic behavior Manic disorder, recurrent episode severe, specified as with psychotic behavior Manic disorder, recurrent episode in partial or unspecified remission Manic disorder, recurrent episode in full remission Major depressive disorder, single episode unspecified Major depressive disorder, single episode mild Major depressive disorder, single episode moderate Major depressive disorder, single episode severe, without mention of psychotic behavior Major depressive disorder, single episode severe, specified as with psychotic behavior Major depressive disorder, single episode in partial or unspecified remission Major depressive disorder, single episode in full remission Major depressive disorder, recurrent episode unspecified Major depressive disorder, recurrent episode mild Major depressive disorder, recurrent episode moderate Major depressive disorder, recurrent episode severe, without mention of psychotic behavior Major depressive disorder, recurrent episode severe, specified as with psychotic behavior Major depressive disorder, recurrent episode in partial or unspecified remission Major depressive disorder, recurrent episode in full remission Bipolar I disorder, most recent episode (or current) manic, unspecified Bipolar I disorder, most recent episode (or current) manic, mild Bipolar I disorder, most recent episode (or current) manic, moderate Bipolar I disorder, most recent episode (or current) manic, severe, without mention of psychotic behavior Bipolar I disorder, most recent episode (or current) manic, severe, specified as with psychotic behavior Bipolar I disorder, most recent episode (or current) manic, in partial or unspecified remission Bipolar I disorder, most recent episode (or current) manic, in full remission Bipolar I disorder, most recent episode (or current) depressed, unspecified Bipolar I disorder, most recent episode (or current) depressed, mild Bipolar I disorder, most recent episode (or current) depressed, moderate Bipolar I disorder, most recent episode (or current) depressed, severe, without mention of psychotic behavior Bipolar I disorder, most recent episode (or current) depressed, severe, specified as Attachment A - Page 3

4 with psychotic behavior Bipolar I disorder, most recent episode (or current) depressed, in partial or unspecified remission Bipolar I disorder, most recent episode (or current) depressed, in full remission Bipolar I disorder, most recent episode (or current) mixed, unspecified Bipolar I disorder, most recent episode (or current) mixed, mild Bipolar I disorder, most recent episode (or current) mixed, moderate Bipolar I disorder, most recent episode (or current) mixed, severe, without mention of psychotic behavior Bipolar I disorder, most recent episode (or current) mixed, severe, specified as with psychotic behavior Bipolar I disorder, most recent episode (or current) mixed, in partial or unspecified remission Bipolar I disorder, most recent episode (or current), mixed, in full remission Bipolar I disorder, most recent episode (or current), unspecified Bipolar disorder, unspecified Atypical manic disorder Atypical depressive disorder Other and unspecified bipolar disorders, other Unspecified episode mood disorder Other specified episodic mood disorder Paranoid state, simple Delusional disorder Paraphrenia Shared psychotic disorder Other specified paranoid states Unspecified paranoid state Depressive type psychoses Excitative type psychoses Reactive confusion Acute paranoid reaction Psychogenic paranoid psychosis Other and unspecified reactive psychosis Unspecified psychosis Autistic disorder, current or active state Autistic disorder, residual state Childhood disintegrative disorder, current or active state Childhood disintegrative disorder, residual state Other specified pervasive developmental disorders, current or active state Other specified pervasive developmental disorders, residual state Attachment A - Page 4

5 Unspecified pervasive developmental disorders, current or active state Unspecified pervasive developmental disorders, residual state Anxiety state, unspecified Panic disorder without agoraphobia Generalized anxiety disorder Neurotic disorders other Hysteria, unspecified Conversion disorder Dissociative amnesia Dissociative fugue Dissociative identity disorder Dissociative disorder or reaction, unspecified Factitious disorder with predominantly psychological signs and symptoms Other and unspecified factitious illness Phobia, unspecified Agoraphobia with panic disorder Agoraphobia without mention of panic attacks Social phobia Other isolated or specific phobias Obsessive-compulsive disorders Dysthymic disorder Neurasthenia Depersonalization disorder Hypochondriasis Somatization disorder Undifferentiated somatoform disorder Other somatoform disorders Unspecified nonpsychotic mental disorder Paranoid personality disorder Affective personality disorder, unspecified Chronic hypomanic personality disorder Chronic depressive personality disorder Cyclothymic disorder Schizoid personality disorder, unspecified Introverted personality Schizotypal personality disorder Explosive personality disorder Obsessive-compulsive personality disorder Histrionic personality disorder, unspecified Chronic factitious illness with physical symptoms Attachment A - Page 5

6 Other histrionic personality disorder Dependent personality disorder Antisocial personality disorder Narcissistic personality disorder Avoidant personality disorder Borderline personality disorder Passive-aggressive personality Other personality disorder Unspecified personality disorder Ego-dystonic sexual orientation Zoophilia Pedophilia Transvestic fetishism Exhibitionism Trans-sexualism with unspecified sexual history Trans-sexualism with asexual history Trans-sexualism with homosexual history Trans-sexualism with heterosexual history Gender identity disorder in children Psychosexual dysfunction, unspecified Hypoactive sexual desire disorder Psychosexual dysfunction with inhibited sexual excitement Female orgasmic disorder Male orgasmic disorder Premature ejaculation Dyspareunia, psychogenic Psychosexual dysfunction with other specified psychosexual dysfunctions Fetishism Voyeurism Sexual masochism Sexual sadism Gender identity disorder in adolescent or adults Other specified psychosexual disorder Unspecified psychosexual disorder Stuttering Tic disorder, unspecified Transient tic disorder Chronic motor or vocal tic disorder Tourette s disorder Stereotyped movement disorder Attachment A - Page 6

7 Nonorganic sleep disorder, unspecified Transient disorder of initiating or maintaining sleep Persistent disorder of initiating or maintaining sleep Transient disorder of initiating or maintaining wakefulness Persistent disorder of initiating or maintaining wakefulness Circadian rhythm sleep disorder Sleep arousal disorder Other dysfunctions of sleep stages or arousal from sleep Other Eating disorder, unspecified Enuresis Encopresis Psychogenic pain, site unspecified Psychalgia Other and unspecified special symptoms or syndromes, not elsewhere classified Predominant disturbance of emotions Predominant disturbance of consciousness Predominant psychomotor disturbance Other acute reactions to stress Mixed disorders as reaction to stress Unspecified acute reaction to stress Adjustment disorder with depressed mood Prolonged depressive reaction Separation anxiety disorder Emancipation disorder of adolescence and early adult life Specific academic or work inhibition Adjustment disorder with anxiety Adjustment disorder with mixed anxiety and depressed mood Other predominant disturbance of other emotions Adjustment disorder with disturbance of conduct Adjustment disorder with disturbance of emotions and conduct Posttraumatic stress disorder Adjustment reaction with physical symptoms Adjustment reaction with withdrawal Other specified adjustment reaction Unspecified adjustment reaction Frontal lobe syndrome 311 Depressive disorder, not elsewhere classified Undersocialized conduct disorder, aggressive type, unspecified Undersocialized conduct disorder, aggressive type, mild Attachment A - Page 7

8 Undersocialized conduct disorder, aggressive type, moderate Undersocialized conduct disorder, aggressive type, severe Undersocialized conduct disorder, unaggressive type, unspecified Undersocialized conduct disorder, unaggressive type, mild Undersocialized conduct disorder, unaggressive type, moderate Undersocialized conduct disorder, unaggressive type, severe Socialized conduct disorder, unspecified Socialized conduct disorder, mild Socialized conduct disorder, moderate Socialized conduct disorder, severe Impulse control disorder, unspecified Pathological gambling Kleptomania Pyromania Intermittent explosive disorder Isolated explosive disorder Other Mixed disturbance of conduct and emotions Conduct disorder, childhood onset type Conduct disorder, adolescent onset type Other conduct disorder Unspecified disturbance of conduct Overanxious disorder Misery and unhappiness disorder Shyness disorder of childhood Introverted disorder of childhood Selective mutism Relationship problems Oppositional defiant disorder Identity disorder Academic underachievement disorder Other Unspecified emotional disturbance of childhood or adolescence Attention deficit disorder Without mention of hyperactivity Attention deficit disorder With hyperactivity Hyperkinesis with developmental delay Hyperkinetic conduct disorder Other specified manifestations of hyperkinetic syndrome Unspecified hyperkinetic syndrome Reading disorder, unspecified Attachment A - Page 8

9 Alexia Developmental dyslexia Other Mathematics disorder Other specific learning difficulties Expressive language disorder Mixed receptive-expressive language disorder Other Developmental coordination disorder Mixed development disorder Other specified delays in development Unspecified delay in development 317 Mild mental retardation Moderate mental retardation Severe mental retardation Profound mental retardation 319 Unspecified mental retardation Attachment A - Page 9

10 ATTACHMENT B ICD-9-CM MENTAL DISORDERS DIAGNOSIS CODES AND DESCRIPTIONS Subject to Certification of Admission/Concurrent/Continued Stay Review This list contains principal diagnosis codes for medical services Category of Service 20 or psychiatric services Category of Service 21. General care hospitals that are not enrolled for COS 21 will continue to bill for a maximum of three days of emergency psychiatric care using COS 20. The description of codes noted in bold has changed based on ICD-9-CM coding guidelines effective Senile dementia, uncomplicated Presenile dementia, uncomplicated Presenile dementia with delirium Presenile dementia with delusional features Presenile dementia with depressive features Senile dementia with delusional features Senile dementia with depressive features Senile dementia with delirium Vascular dementia, uncomplicated Vascular dementia, with delirium Vascular dementia, with delusions Vascular dementia, with depressed mood Other specified senile psychotic conditions Unspecified senile psychotic condition Alcohol withdrawal delirium Alcohol-induced persisting amnestic disorder Alcohol-induced persisting dementia Alcohol-induced psychotic disorder with hallucinations Idiosyncratic alcohol intoxication Alcohol-induced psychotic disorder with delusions Alcohol withdrawal Other specified alcohol-induced mental disorders Unspecified alcohol-induced mental disorders Drug withdrawal Drug-induced psychotic disorder with delusions Drug-induced psychotic disorder with hallucinations Pathological drug intoxication Drug-induced delirium Drug-induced persisting dementia Drug-induced persisting amnestic disorder Drug-induced mood disorder Attachment B - Page 1

11 ATTACHMENT B - continued Other Unspecified drug-induced mental disorder Subacute delirium Physiological malfunction arising from mental factors Musculoskeletal Physiological malfunction arising from mental factors Respiratory Physiological malfunction arising from mental factors Cardiovascular Physiological malfunction arising from mental factors Skin Physiological malfunction arising from mental factors Gastrointestinal Psychogenic genitourinary malfunction, unspecified Psychogenic vaginismus Psychogenic dysmenorrhea Psychogenic dysuria Other Endocrine Organs of special sense Other specified psychophysiological malfunction Unspecified psychophysiological malfunction Anorexia nervosa Repetitive intrusions of sleep Bulimia nervosa Pica Rumination disorder Psychogenic vomiting Other Tension headache Other, pain disorder related to psychological factors Postconcussion syndrome Other specified nonpsychotic mental disorders following organic brain damage Unspecified nonpsychotic mental disorder following organic brain damage 316 Psychic factors associated with diseases classified elsewhere Attachment B - Page 2

12 ATTACHMENT C ICD-9-CM DIAGNOSIS CODES Subject to Certification and Concurrent/Continued Stay Review Note: Several codes have been added based on the ICD-9-CM coding guidelines. Descriptions of some codes have also changed based on ICD-9-CM coding guidelines effective 10/01/04. New codes are denoted by an asterisk (*). Description changes are noted in bold. Category Description of Diagnosis Streptococcal Septicemia Staphylococcal Septicemia, unspecified Staphylococcus aureus septicemia Other Staphylococcal septicemia Gram-negative organism, unspecified Escherichia coli (E. Coli) Pseudomonas Septicemia due to other gram-negative organisms Other Other specified septicemias Unspecified septicemia Diabetes mellitus without (w/o) mention of complication, type II or unspecified type, not stated as uncontrolled Diabetes mellitus w/o mention of complication type I [juvenile type], not stated as uncontrolled Diabetes mellitus w/o mention of complication, type II or unspecified type, uncontrolled Diabetes mellitus w/o mention of complication, type I [juvenile type], uncontrolled Diabetes with other specified manifestations, type II or unspecified type, not stated as controlled * Diabetes with other specified manifestations, type I [juvenile type], not stated as uncontrolled Diabetes with other specified manifestations, type II or unspecified type, uncontrolled Diabetes with other specified manifestations type I [juvenile type], uncontrolled Disorders of fluid, electrolyte, and acid- base balance, Volume Depletion Iron Deficiency anemia Secondary to blood loss (chronic) Iron Deficiency anemia, unspecified Hb-S disease with mention of crisis Essential hypertension, malignant Essential hypertension, unspecified Attachment C - Page 1

13 ATTACHMENT C - continued Hypertensive renal disease, with renal failure * Venous embolism and thrombosis of unspecified deep vessels of lower extremity * Venous embolism and thrombosis of proximal lower extremity * Venous embolism and thrombosis of deep vessels of distal lower extremity Other venous embolism and thrombosis of other specified veins. 486 Pneumonia, organism unspecified 490 Bronchitis, not specified as acute or chronic Obstructive Chronic bronchitis without mention of acute exacerbation Obstructive Chronic bronchitis with acute exacerbation * Obstructive Chronic bronchitis with acute bronchitis Acute respiratory failure Other pulmonary insufficiency, not elsewhere classified Esophageal reflux Acute gastritis without mention of hemorrhage Other specified gastritis without mention of hemorrhage Unspecified gastritis and gastroduodenitis without mention of hemorrhage Other and unspecified noninfectious gastroenteritis and colitis Alcoholic cirrhosis of liver Alcoholic liver damage, unspecified 585 Chronic renal failure Urinary tract infection, site not specified * Decubitus ulcer, unspecified site * Decubitus ulcer, elbow * Decubitus ulcer, upper back * Decubitus ulcer, lower back * Decubitus ulcer, hip * Decubitus ulcer, buttock * Decubitus ulcer, ankle * Decubitus ulcer, heel * Decubitus ulcer, other site Unspecified ulcer of lower limb Ulcer of thigh Ulcer of calf Ulcer of ankle Ulcer of heel and midfoot Ulcer of other part of foot Ulcer of other part of lower limb Lumbago Attachment C Page 2

14 ATTACHMENT C - continued Syncope and collapse Other convulsions Dizziness and giddiness Anorexia Symptoms involving respiratory system and other chest symptoms, other Chest pain unspecified Chest pain other Abdominal pain unspecified site Abdominal pain right lower quadrant Abdominal pain left lower quadrant Fracture of clavicle closed unspecified part Fracture of femur shaft, closed Fracture of one or more metatarsal bone(s) Attachment C Page 3

15 ATTACHMENT D DRG Codes Subject to Prepayment Review DRG DESCRIPTION 386* Extreme Immaturity or Respiratory Distress Syndrome 986* Extreme Immaturity or Respiratory Distress Syndrome 468 Extensive OR Procedure Unrelated to Principal Diagnosis 477 Non-Extensive OR Procedure Unrelated to Principal Diagnosis 025 Seizure & Headache, Age > 17 years, Without Complications and Comorbidities 098 Bronchitis and Asthma, Age 0-17 years 134 Hypertension 143 Chest Pain 182 Esophagitis, Gastroenteritis, & Miscellaneous Digestive Disorders, Age > 17 years, With Complications and Comorbidities 183 Esophagitis, Gastroenteritis, & Miscellaneous Digestive Disorders, Age > 17 years, Without Complications and Comorbidities 184 Esophagitis, Gastroenteritis, & Miscellaneous Digestive Disorders, Age 0-17 years 243 Medical Back Problems 369 Menstrual and Other Female Reproductive System Disorders 381 Abortion with Dilation and Curettage, Aspiration Curettage or Hysterotomy 410 Chemotherapy Without Acute Leukemia as Secondary Diagnosis 435 Alcohol/Drug Abuse or Dependence, Detoxification or Other Symptomatic Treatment, Without Complications and Comorbidities * Code Added Effective 08/01/04 Attachment D Page 1