Information for Lesson 10

Information for Lesson 10 Information regarding completion of the PASRR screen also known as (ODJFS 3622) or RR/ID To wrap up the course, we will discuss information related to the PASRR screen 3622. We have talked about this screen throughout the course. In this lesson, we will review the sections of the screen and discuss aspects of completing it. Again, there are a few different names that we call this instrument. The technical name is ODJFS 3622. It is also called the PASRR Screen, RR/ID or Resident Review Identification, depending on the situation in which you use it. Section A- Identifying Information Please make sure accurate information is entered in Section A-Individual s full name (last, first), sex, and date of birth, social security number and status of Medicaid, Managed Care Plan Name (If Applicable), and if the Individual has Health Care Insurance with another company. Also living arrangement should be specified. PAS (Preadmission Screening) applies to 1 and 2 of Section B. RR (Resident Review) applies to 3-7 of the Section B. (See below for more clarification on what each number relates to) Section B- Reason For Screening Preadmission Screening Codes (1 and 2) 1. Ohio Resident Seeking Nursing Facility Admission - Used for admissions only (Please review difference between admission and readmission). New Admission is defined in 5101:3-3-59, A (1) of the Ohio Administrative Code as, The status of an individual who was not considered to be a resident of any Ohio Medicaid certified NF immediately preceding the current NF admission including the status of any individual who was formerly a NF resident but who exhausted their bed hold days while in the community. Admissions are distinguished from a readmission or return of resident on bed hold status. If the individual was admitted to the NF from the hospital (And the Individual was residing in the Community prior to the Hospitalization) without a PAS or Valid Hospital Exemption, the NF should submit the screen (coded 1) to Preadmission Review with medical information such as the hospital transfer form or signed/dated physician orders page with diagnoses and medications. Also, if the individual was admitted directly from the community without a PAS, the NF 1

should still code the PASRR 1 and submit to Preadmission Review for a PAS with the medical information. 2. Out of State Resident Seeking Nursing Facility Admission (See all of our Information in Lesson 5 for Out of State to Ohio NF Protocol) Resident Review Codes-For Each one of these (Codes 3-7) the person completing the form is asked to choose from 1 of 3 options a. Seeking Approval for an Unspecified Amount of Time. b. Seeking Approval for a Specified Period of Time- Section G(1) will need to be completed as well as the remainder of this form c. Seeking an Extension to an Approved Resident Review for a Specified Period of Time- Section G(2) as well as the remainder of the form needs to be completed. 3. Expired Time Limit For Hospital Exemption - Only used for individuals admitted directly from the hospital after an inpatient stay (see Community to Hospital to NF < 30 Day Stay) for additional information. This cannot be used for individuals who are admitted from a hospital psychiatric unit because you cannot have a 7000 Hospital Exemption for an admission from a hospital psychiatric unit. 4. Expired Time Limit for Emergency Admission This code is used for individual s who already have been admitted to the NF from the community due to an emergency (The individual who required NF placement triggers for Mental Illness and/or MR/DD). Paperwork (ODJFS 3622 coded 1, NF applicant and medical information) was forwarded to PASSPORT Preadmission Review. Preadmission Review forwarded the paperwork to the appropriate state authority. The state authority (ODMH and/or DODD) granted a 7-day admission (see Community to NF, Emergency Admission). If the individual is still residing in the NF on the 7 th day after admission to the NF, the NF must complete and code 4 and forward the screen to the state authority with medical information by the 7 th day after admission. The state will determine if the individual can continue to reside in the NF. 5. Expired Time Limit for Respite Admission- This code is used for individual s who have already been admitted to the NF from the community for the purpose of a respite stay. The individual who was placed for respite purposes triggered for Mental Illness or MR/DD. The NF should complete the RR/ID (code it 5) and forward to the proper state authority. This information would be noted on the further review results that were received upon admission. For a Medicaid respite admission, the individual is supposed to have an in person LOC assessment by a LSW or RN from the PASSPORT site. Once 2

the assessment is completed, the paperwork is forwarded to the appropriate state authority. Once Preadmission Review receives the determination, they will issue the LOC and PAS for admission to the NF. If the individual is still in the NF on the 14 th day after admission to the NF, the NF should complete the PASRR screen, Code it 5- expired time limit for respite admission and forward the screen with medical information to the appropriate state authority. 6. NF Transfer -No Previous PASRR Records The only instance when a PASRR is coded 6 is, When an individual is admitted from a new Medicaid certified NF, either directly from another Medicaid certified NF or via the hospital from another Medicaid certified NF. The original NF did not receive the proper PASRR requirement upon admission, or the original NF is unable to locate the proper PAS requirement, or Preadmission Review has no record of a PASRR requirement from the original NF and cannot provide to the NF. In any case it either was not done or it cannot be located. The receiving NF has to be vigilant of this matter. The PASRR screen should be completed and coded 6 right away upon admission if a valid PAS requirement is not obtained from the previous NF. If the screen triggers for mental illness or MR/DD, it should be forwarded to the appropriate state authority with medical documentation. If the screen does not trigger, it should be kept on the patient s chart. 7. Significant Change in Condition- As soon as the NF has reason to believe a significant change may have occurred with a resident, a PASRR screen-coded 7 should be completed for an individual with indications of MR/DD (Mental Retardation/Developmental Disorder) or SMI (Severe Mental Illness) and must be submitted to DODD and/or Ascend within seventy-two hours following identification of the significant change. This include a NF resident who has been admitted to a hospital psychiatric unit -A new PASRR screen coded 7 needs to be completed by the NF within 72 hours of the resident being admitted to the psychiatric unit. Or, from the Definitions of Significant Change of Condition including any major decline or improvement in condition. At least one of the following criteria is met: (a) There is a change in the individual's current diagnosis(es), mental health treatment, functional capacity, or behavior such that, as a result of the change, the individual who did not previously have indications of SMI, or who did not previously have indications of MRDD, now has such indications (this includes any individual who may have had indications of one or the other but now has indications of both SMI and MRDD), or who was previously determined by ODMH not to have SMI but who now meets all three of the defining criteria for SMI (set forth in 3

paragraphs (B)(3)(a)(i) to (B)(3)(a)(iii) of rule 5101:3-3-15.1 of the Administrative Code); or (b) The change is such that it may impact the mental health treatment or placement options of an individual previously identified as having SMI and/or may result in a change in the specialized services needs of an individual previously identified as having MRDD. There are many instances where this can happen- Any time there is a significant improvement or deterioration (physical or mental) in an individual's condition as it relates to a mental illness or MR/DD. Three examples are listed below. 1. An example of a physical condition could be a person who's PASRR triggered for mental illness. He was approved for NF admission for physical therapy. Through PT rehab, his condition improves. A new screen should be completed for significant change in condition.. 2. Anytime a NF resident enters a hospital psychiatric unit a new screen should be completed within 72 hours of the admission for a significant change in condition. 3. An individual is a resident of the NF. He is given a new mental illness diagnosis or MR/DD diagnosis. A screen should be completed for significant change in condition. Any time you have a question as to whether you should complete a new PASRR for a significant change in condition, you can contact ODMH at 1-614-466-1063 and ask to speak with one of the PASRR evaluator. Instead of going through section by section of the screen, we are going to go through our normal routine of providing question and answers. This time regarding the PASRR screen. If you have further questions which have not addressed, please feel free to forward your questions to us like usual. Chapter 10. Q&A Regarding Completion of the PASRR Screen 1. Question: What are some of the names that relate to the PASRR screen? Answer: It is called ODJFS 3622, Ohio PASRR screen, and RR/ID (Resident Review Identification). 2. Question: What codes of the PASRR screen (Section B) relate to Preadmission and which relate to Resident Review? Answer: Codes 1 and 2 of section B relate to Preadmission (Preadmission Review issues 4

a PAS) and codes 3-7 relate to resident review (NF worker is responsible- State authority issues determination if applicable). 3. Question: If a NF completes a PASRR Screen and it triggers for mental illness and/or MR/DD for codes 3-7 of section B of the screen, where should the NF forward the screen? Answer: To the state authorities-the contract Agency for ODMH is called Kepro. Fax for Ohio Mental Health Authority is 1-(844) 610-6736. Phone for Ohio Mental Health Authority is 1-(614) 357-4584 Phone for DODD is 1-614-728-0183. DODD fax is (614) 995-4877.. 4. Question: When does a NF complete a PASRR screen and code it 6-No previous PASRR records? Answer: The only time a PASRR screen is completed and coded 6, is when and individual is admitted to a Medicaid certified from another Medicaid certified NF (either directly or via a hospital) and the previous Medicaid certified NF is unable to provide a valid PAS requirement. If this occurs, the receiving NF should complete the PASRR screen as soon as it realizes that someone was admitted from another Medicaid certified NF without a PAS requirement. If it triggers for mental illness of MR/DD, it should be forwarded to the appropriate state authorities. 5. Question: What section of the PASRR screen are the diagnoses alcohol abuse and tobacco abuse addressed? Answer: Alcohol abuse, drug abuse, drug dependency, tobacco abuse, cocaine abuse, etc. are addressed in section D of the PASRR screen. In question 1 of section D, these diagnoses would be addressed in letter h (another mental disorder other than MR that may lead to a chronic disability). You should write the diagnoses on the line. However, the Ohio Department of Mental Health has indicated that you should only address substance abuse disorders on the screen if the individual has another mental disorder. If the substance abuse is the person's only mental disorder than it should not be addressed on the screen. 6. Question: If an individual has a diagnosis of both dementia and mental retardation (MR) does the PASRR screen still trigger for further review? Answer: Yes, the PASRR screen would trigger for MR even though the individual has a diagnosis of dementia. 5

7. Question: If an individual has a dementia diagnosis and a diagnosis of a mental illness such as schizophrenia, what must be specified next to one of individual's diagnoses? Answer: If an individual has a diagnosis of dementia and a mental disorder, one of the individual's diagnoses must be specified as a primary diagnosis. This can be accomplished by putting the word Primary next to it or (P) next to it. 8. Question: What section of the PASRR screen should the diagnosis delirium need to be addressed? Answer: The diagnosis delirium should be addressed in section C of the PASRR screen. 9. Question: Under what circumstances is a PASRR screen be completed and coded 7- significant change in condition? Answer: There are many instances where this can happen- Any time there is a significant improvement or deterioration (physical or mental) in an individual's condition as it relates to a mental illness or MR/DD. Some examples are listed below. 1. An example of a physical condition could be a person who's PASRR triggered for mental illness. He was approved for NF admission for physical therapy. Through PT rehab, his condition improves. A new screen should be completed for significant change in condition.. 2. Anytime a NF resident enters a hospital psychiatric unit a new screen should be completed within 72 hours of the admission for a significant change in condition. 3. An individual is a resident of the NF. He is given a new mental illness diagnosis or MR/DD diagnosis. A screen should be completed for significant change in condition. 4. A person with a significant mental health disorder who enters a hospital for medical reasons and his/her PASRR screen triggers for mental illness. 10. Question: An individual is residing in the community. She is admitted for an inpatient stay at a hospital. She is discharged from the hospital to a Medicaid certified NF. The individual is admitted to the NF without a PAS or a hospital exemption. What code (1-7) should be marked in section B of the PASRR screen when it is submitted with medical information to Preadmission Review? Answer: In this instance, the individual would still be considered a NF applicant. It should be coded 1 and forwarded to Preadmission Review with medical information for 6

a PAS. 11. Question: What section of the PASRR screen should the diagnoses cerebral palsy, epilepsy, spina bifida, polio, and muscular dystrophy be addressed? Answer: Developmental disorders such as the one listed above should be addressed in section E of the PASRR screen (Question 2). Questions 3, 4, 5, and 6 should be completed based on the diagnosis. 12. Question: Under what circumstance should the PASRR screen be completed and coded 5-expired time limit for respite admission? Answer: This code is used for individual s who have already been admitted to the NF from the community for the purpose of a respite stay. The individual who was placed for respite purposes triggered for Mental Illness or MR/DD. The NF should complete the RR/ID (code it 5) and forward to the proper state authority. This information would be noted on the further review results that were received upon admission. For a Medicaid respite admission, the individual is supposed to have an in person LOC assessment by a LSW or RN from the Area Agency Site. Once the assessment is completed, the paperwork is forwarded to the appropriate state authority. Once Preadmission Review receives the determination, they will issue the LOC and PAS for admission to the NF. If the individual is still in the NF on the 14 th day after admission to the NF, the NF should complete the PASRR screen, Code it 5- expired time limit for respite admission and forward the screen with medical information to the appropriate state authority. 13. Q: For question 3 of section D of the PASRR, if an individual suffered a CVA and is unable to complete the tasks listed due to the CVA should they be checked? A: No, if an individual is unable to complete the tasks listed in question 3 of section D of the PASRR because of a CVA, they should not be checked. The tasks are only checked if the individual is unable to complete due the mental disorder listed in question 1 of section D. 14. Question: What section of the PASRR screen is the diagnosis Schizophrenia addressed? Answer: A Schizophrenic disorder should be addressed in question 1 of section D. The rest of the questions of section D should be completed based on the schizophrenia (and other mental disorders which the individual may have). 7

15. Question: Under what circumstance is a PASRR screen completed and coded 4- expired time limit for emergency admission? Answer: This code is used for individual s who already have been admitted to the NF from the community due to an emergency (The individual who required NF placement triggers for Mental Illness and/or MR/DD). Paperwork (ODJFS 3622 coded 1, NF applicant and medical information) was forwarded to PASSPORT Preadmission Review. Preadmission Review forwarded the paperwork to the appropriate state authority. The state authority (Ascend and/or DODD) granted a 7-day admission (see Community to NF, Emergency Admission). If the individual is still residing in the NF on the 7th day after admission to the NF, the NF must complete and code 4 and forward the screen to the state authority with medical information by the 7th day after admission. The state will determine if the individual can continue to reside in the NF. 16. Question: On the previous PASRR screen if the person being screened had a primary diagnosis of dementia I could skip section D of the PASRR screen, can I do this on the new PASRR screen? Answer: On the most recent PASRR screen (11/10), you cannot skip section D of the PASRR, you must answer all of the questions in section C and section D no matter if the person has a primary diagnosis of dementia. 17. Question: I am a nursing home social worker. One of my residents enters a hospital psychiatric unit. I complete a PASRR screen and code 7 within 72 hours after the admission like I am supposed to do. The screen triggers for mental illness and I fax it to Ascend. The individual is out of bed hold days for the year so a new LOC is needed. A new LOC cannot be issued until a determination from Ascend. Can I readmit him to my NF prior to the determination being issued and then obtain the LOC at a later date back to the date of admission? Answer: Preadmission Review cannot issue a LOC prior to a determination being made by the mental health authority. So, I would not readmit the person until I know that he/she is approved and I have the LOC in my possession. Sometimes it gets sticky with the hospital not wanting to hold the person, but it does take a lot of cooperation between the NF and the hospital in completing the paperwork in a timely fashion and getting it to where it is supposed to go. 18. Question: Does a person need a new PASRR screen normally need to be completed 8

for a change in medical condition? Answer: There has been some confusion on this but generally it does not need to be completed. However, if you have a question on a specific decline or improvement in condition and mental health can be attributed to it, the screen may need to be completed. I would contact the state mental health authority at 1-614-466-1063 and ask for an evaluator for clarification on a specific situation that you might have. 19. Question: What are instances when I check # 1 (Ohio Resident Seeking Nursing Facility Admission) of section B of the PASRR screen (ODJFS 3622)? Answer: You would check # 1 of section B whenever a PAS (Preadmission Screen) is being requested. Some instances include, Any admission from the community, Admission from the hospital when anticipated length of stay is greater than 30 days and a hospital exemption is not completed for the admission. 20. Question: I am a social worker at a Medicaid certified NF. I complete a PASRR screen and code 3 for an expired hospital exemption. The screen triggers for mental illness and I fax to Ascend for further review. I receive a determination from Ascend and it indicates that the person is approved for a length of stay of 150 days. What is my responsibility as it gets near 150 days? Answer: You should complete a new PASRR screen by 30 days from the approved date. In this example, the person was approved for 150 days. If the person is still in the NF, the PASRR screen should be completed 30 days prior to 150 days (Day 120), coded 7 significant change in condition, and faxed back to Kepro (Their fax is 1-844-285-9764). 21. Question: In question 3 of section D of the PASRR screen, when should I check off the function limitations listed in the question? Answer: You should only check off those functional limitations that have occurred within the last six months that are only related the the mental disorder(s) that you addressed in Question 1 of section D. If the functional limitation was the result of of physical problem such as paralysis due to a CVA, then you would not check off the functional limitation. 22. Question: In Question 4 of section D (Within the past 2 years, has the individual received SSI or SSDI due to a mental impairment?) is answered yes, does this automatically trigger the screen to go for further review? 9

Answer: Yes 23. What are diagnoses that I would address in sections C and D of the PASRR screen? Answer: See the information after the Lesson 10 post test. There are too many to list in this question & answer section. 24. What are some examples of disorders that would be addressed in questions 1 and 2 of section E of the PASRR screen? Answer: For Question 1 of Section E 317 Mild Mental Retardation 318.0 Moderate Mental Retardation 318.1 Severe Mental Retardation 318.2 Profound Mental Retardation 319 Mental Retardation, Severity Unspecified For Question 2- Section E (This list is not exhaustive but are examples of what you would address in question 2 of Section E) Aids Autism Spectrum Disorders Blindness Chromosomal Abnormalities Cerebral Palsy Closed Head Injury Deafness Various forms of Diseases that occurred prior to age 22 Epilepsy/Seizure Disorder Hydro/Micro/Macrocephaly Multiple Sclerosis Muscular Dystrophy Para/Quadriplegia Polio Spina Bifida Spinal Cord Injury due to MVA, gun shot wound, etc. Traumatic Brain Injury 10

Also Various Syndromes (i.e. Down s, Hurler s, Prader-Willi, Tourettes, etc.) Post Test for Lesson 10-1. If an individual has a diagnosis of both dementia and mental retardation the PASRR screen would trigger for further review -True/False 2. For question 3 of section D of the PASRR screen, an individual has a diagnosis of schizophrenia but suffered a CVA and is unable to complete many of the tasks listed due to the CVA and not the schizophrenia. Those tasks that he is not able to complete due to the CVA should be checked- True/False 3. The terms ODJFS 3622, PASRR screen and RR/ID all refer to the same form- True/False 4. The diagnoses cerebral palsy, epilepsy, spina bifida, polio, and muscular dystrophy should be addressed in section E of the PASRR screen-true/false 5. If a NF completes a PASRR Screen and it triggers for mental illness and/or MR/DD for codes 3-7 of section B of the screen, the worker at the NF should forward it to either Kepro or DODD or both depending on what it triggers for- True/False Bonus Question- 6. This was an informative, worthwhile training True/False We have provided a list of diagnoses for Sections C & D of the PASRR Screen Below The codes listed below are from the DSM IV TR. There are different codes on the DSM 5 but generally the diagnosis listed below are very similar. Information and Diagnoses for Section C of the PASRR screen- Also known as RR/ID or ODJFS 3622. Section C Diagnoses for Section C of the PASRR Screen-This is not an exhaustive list. 290.40 Vascular Dementia, Uncomplicated 290.41 Vascular Dementia, With Delirium 11

290.42 Vascular Dementia, With Delusions 290.43 Vascular Dementia, With Depressed Mood 291.0 Alcohol Intoxication Delirium 291.0 Alcohol Withdrawal Delirium 291.1 Alcohol-Induced Persisting Amnestic Disorder 291.2 Alcohol-Induced Persisting Dementia 291.3 Alcohol-Induced Psychotic Disorder, With Hallucinations 291.5 Alcohol-Induced Psychotic Disorder, with Delusions 291.81 Alcohol Withdrawal 291.89 Alcohol-Induced Anxiety Disorder 291.89 Alcohol-Induced Mood Disorder 291.89 Alcohol-Induced Sexual Dysfunction 291.89 Alcohol-Induced Sleep Disorder 291.9 Alcohol-Related Disorder NOS 292.0 Amphetamine Withdrawal 292.0 Cocaine Withdrawal 292.0 Nicotine Withdrawal 292.0 Opioid Withdrawal 292.0 Other (or Unknown) Substance Withdrawal 292.0 Sedative, Hypnotic, or Anxiolitic Withdrawal 292.11 Amphetamine-Induced Psychotic Disorder, With Delusions 292.11 Cannabis-Induced Psychotic Disorder, With Delusions 292.11 Cocaine-Induced Psychotic Disorder, With Delusions 292.11 Hallucinogen-Induced Psychotic Disorder, With Delusions 292.11 Inhalant-Induced Psychotic Disorder, With Delusions 292.11 Opioid-Induced Psychotic Disorder, with Delusions 292.11 Other (or Unknown) Substance-Induced Psychotic Disorder, With Delusions 292.11 Phencyclidine-Induced Psychotic Disorder, With Delusions 292.11 Sedative-, Hypnotic, or Anxiolitic-Induced Psychotic Disorder, With Delusions 292.12 Amphetamine-Induced Psychotic Disorder, With Hallucinations 292.12 Cannabis-Induced Psychotic Disorder, With Hallucinations 292.12 Cocaine-Induced Psychotic Disorder, With Hallucinations 292.12 Inhalant-Induced Psychotic Disorder, With Hallucinations 292.12 Opioid-Induced Psychotic Disorder, With Hallucinations 292.12 Other (or Unknown) Substance-Induced Psychotic Disorder, With Hallucinations 292.12 Phencyclidine-Induced Psychotic Disorder, With Hallucinations 292.12 Sedative-, Hypnotic-, or Anxiolitic-Induced Psychotic Disorder, With 12

Hallucinations 292.81 Amphetamine Intoxication Delirium 292.81 Cannabis Intoxication Delirium 292.81 Cocaine Intoxication Delirium 292.81 Hallucinogen Intoxication Delirium 292.81 Inhalant Intoxication Delirium 292.81 Opiod Intoxication Delirium 292.81 Other (or unknown) Substance-Induced Delirium 292.81 Phencyclidine Intoxication Delirium 292.81 Sedative, Hypnotic, or Anxiolytic Intoxication Delirium 292.81 Sedative, Hypnotic, or Anxiolytic Withdrawal Delirium 292.82 Inhalant-Induced Persisting Dementia 292.83 Other (or Unknown) Substance-Induced Persisting Dementia 292.83 Sedative-, Hypnotic, or Anxiolytic-Induced Persisting Amnestic Disorder 292.84 Amphetamine-Induced Mood Disorder 292.84 Cocaine Induced Mood Disorder 292.84 Hallucinogen-Induced Mood Disorder 292.84 Inhalant-Induced Mood Disorder 292.84 Opioid Induced Mood Disorder 292.84 Other (or Unknown) Substance-Induced Mood Disorder 292.84 Phencyclidine-Induced Mood Disorder 292.84 Sedative-, Hypnotic-, or Anxiolytic Induced Mood Disorder 292.89 Amphetamine-Induced Anxiety Disorder 292.89 Amphetamine-Induced Sexual Dysfunction 292.89 Amphetamine-Induced Sleep Disorder 292.89 Amphetamine Intoxication 292.89 Caffeine-Induced Anxiety Disorder 292.89 Caffeine-Induce Sleep Disorder 292.89 Cannabis Intoxication 292.89 Cannabis-Induced Anxiety Disorder 292.89 Cocaine-Induced Sexual Dysfunction 292.89 Cocaine-Induced Sleep Disorder 292.89 Cocaine Intoxication 292.89 Hallucinogen-Induced Anxiety Disorder 292.89 Hallucinogen Intoxication 292.89 Hallucinogen Persisting Perception Disorder 292.89 Inhalant-Induced Anxiety Disorder 292.89 Inhalant Intoxication 292.89 Opioid-Induced Sexual Dysfunction 292.89 Opioid-Induced Sleep Disorder 13

292.89 Opioid Intoxication 292.89 Other (or Unknown) Substance-Induced Anxiety Disorder 292..89 Other (or Unknown) Substance-Induced Sexual Dysfunction 292.89 Other (or Unknown) Substance-Induced Sleep Disorder 292.89 Other (or Unknown) Substance Intoxication 292.89 Phencyclidine Intoxication 292.89 Sedative-, Hypnotic-, or Anxiolytic-Induced Anxiety Disorder 292.89 Sedative-, Hypnotic-, or Anxiolytic-Induced Sexual Dysfunction 292.89 Sedative-, Hypnotic-, or Anxiolytic-Induced Sleep Disorder 292.89 Sedative-, Hypnotic-, or Anxiolytic Intoxication 292.9 Amphetamine-Related Disorder NOS 292.9 Caffeine-Related Disorder NOS 292.9 Cannabis-Related Disorder NOS 292.9 Cocaine-Related Disorder NOS 292.9 Hallucinogen-Related Disorder NOS 292.9 Inhalant-Related Disorder NOS 292.9 Nicotine-Related Disorder NOS 292.9 Opioid-Related Disorder NOS 292.9 Other (or Unknown) Substance-Related Disorder NOS 292.9 Phencyclidine-Related Disorder NOS 292.9 Sedative-, Hypnotic-, or Anxiolytic-Related Disorder NOS 293.0 Delirium Due to [Indicate the General Medical Condition] 293.81 Psychotic Disorder due to [Indicate the General Medical Condition], With Hallucinations 293.82 Psychotic Disorder due to [Indicate the General Medical Condition], With Hallucinations 293.83 Mood disorder due to [Indicate the General Medical Condition] 293.84 Anxiety Disorder due to [Indicate the General Medical Condition] 293.89 Catatonic Disorder due to [Indicate the General Medical Condition] 293.9 Mental Disorder NOS due to [Indicate the General Medical Condition] 294.0 Amnestic Disorder Due to [Indicate the General Medical Condition] 294.10 Dementia Due to [Indicate the General Medical Condition], Without Behavioral Disturbance 294.10 Dementia of the Alzheimer s type, With Early Onset, Without Behavioral Disturbance 294.10 Dementia of the Alzheimer s Type, With Late Onset, Without Behavioral Disturbance 294.11 Dementia due to [Indicate the General Medical Condition], With Behavioral Disturbance 14

294.11 Dementia of the Alzheimer s Type, with Early Onset, With Behavioral Disturbance 294.11 Dementia of the Alzheimer Type, With Late Onset, With Behavioral Disturbance 294.8 Amnestic Disorder NOS 294.9 Cognitive Disorder NOS 310.1 Personality Change Due to [Indicate the General Medical Condition] 780.09 Delirium NOS Information and Diagnoses for Section D of the PASRR Screen- Also known as RR/ID or ODJFS 3622 Diagnoses for Section D of the PASRR Screen-This is not an exhaustive list 295.10 Schizophrenia, Disorganized Type 295.20 Schizophrenia, Catatonic Type 295.30 Schizophrenia, Paranoid Type 295.40 Schizophreniform Disorder 295.60 Schizophrenia, Residual Type 295.70 Schizoaffective Disorder 295..90 Schizophrenia, Undifferentiated Type 296.00 Bipolar I Disorder, Single Manic Episode, Unspecified 296.01 Bipolar I Disorder, Single Manic Episode, Mild 296.02 Bipolar I Disorder, Single Manic Episode, Moderate 296.03 Bipolar I Disorder, Single Manic Episode, Severe Without Psychotic Features 296.04 Bipolar I Disorder, Single Manic Episode, Severe With Psychotic Features 296.05 Bipolar I Disorder, Single Manic Episode, In Partial Remission 296.06 Bipolar I Disorder, Single Manic Episode, In Full Remission 296.20 Major Depressive Disorder, Single Episode, Unspecified 296.21 Major Depressive Disorder, Single Episode, Mild 296.22 Major Depressive Disorder, Single Episode, Moderate 296.23 Major Depressive Disorder, Single Episode, Severe Without Psychotic Features 296.24 Major Depressive Disorder, Single Episode, Severe With Psychotic Features 15

296.25 Major Depressive Disorder, Single Episode, In Partial Remission 296.26 Major Depressive Disorder, Single Episode, In Full Remission 296.30 Major Depressive Disorder, Recurrent, Unspecified 296.31 Major Depressive Disorder, Recurrent, Mild 296.32 Major Depressive Disorder, Recurrent, Moderate 296.33 Major Depressive Disorder, Recurrent, Severe With Psychotic Features 296.34 Major Depressive Disorder, Recurrent, Severe Without Psychotic Features 296.35 Major Depressive Disorder, Recurrent, In Partial Remission 296.36 Major Depressive Disorder, Recurrent, In Full Remission 296.40 Bipolar I Disorder, Most Recent Episode Hypomanic 296.40 Bipolar I Disorder, Most Recent Episode Manic, Unspecified 296.41 Bipolar I Disorder, Most Recent Episode Manic, Mild 296.42 Bipolar I Disorder, Most Recent Episode Manic, Moderate 296.43 Bipolar I Disorder, Most Recent Episode Manic, Severe Without Psychotic Features 296.44 Bipolar I Disorder, Most Recent Episode Manic, Severe With Psychotic Features 296.45 Bipolar I Disorder, Most Recent Episode Manic, In Partial Remission 296.46 Bipolar I Disorder, Most Recent Episode Manic, In Full Remission 296.50 Bipolar I Disorder, Most Recent Episode Depressed, Unspecified 296.51 Bipolar I Disorder, Most Recent Episode Depressed, Mild 296.52 Bipolar I Disorder, Most Recent Episode Depressed, Moderate 296.53 Bipolar I Disorder, Most Recent Episode Depressed, Severe Without Psychotic Features 296.54 Bipolar I Disorder, Most Recent Episode Depressed, Severe With Psychotic Features 296.55 Bipolar I Disorder, Most Recent Episode Depressed, In Partial Remission 296.56 Bipolar I Disorder, Most Recent Episode Depressed, In Full Remission 296.60 Bipolar I Disorder, Most Recent Episode Mixed, Unspecified 296..61 Bipolar I Disorder, Most Recent Episode Mixed, Mild 296.62 Bipolar I Disorder, Most Recent Episode Mixed, Moderate 296.63 Bipolar I Disorder, Most Recent Episode Mixed, Severe Without Psychotic Features 296.64 Bipolar I Disorder, Most Recent Episode Mixed, Severe With Psychotic Features 296.65 Bipolar I Disorder, Most Recent Episode Mixed, In Partial Remission 296.66 Bipolar I Disorder, Most Recent Episode Mixed, In Full Remission 296.7 Bipolar I Disorder, Most Recent Episode Unspecified 296.80 Bipolar Disorder NOS 296.89 Bipolar II Disorder 16

296.90 Mood Disorder NOS 297.1 Delusional Disorder 297.3 Shared Psychotic Disorder 298.8 Brief Psychotic Disorder 298.9 Psychotic Disorder NOS 300.0 Anxiety Disorder NOS 300.01 Panic Disorder without Agoraphobia 300.02 Generalized Anxiety Disorder 300.11 Conversion Disorder 300.12 Dissociative Amnesia 300.13 Dissociative Fugue 300.14 Dissociative Identity Disorder 300.15 Dissociative Disorder NOS 300.16 Factitious Disorder with Predominantly Psychological Signs and Symptoms 300.19 Factitious Disorder NOS 300.19 Factitious Disorder with Combined Psychological And Physical Signs and Symptoms 300.21 Panic Disorder with Agoraphobia 300.22 Agoraphobia without History of Panic Disorder 300.23 Social Phobia 300.29 Specific Phobia 300.3 Obsessive-Compulsive Disorder 300.4 Dysthymic Disorder 300.6 Depersonalization Disorder 300.7 Body Dysmorphic Disorder 300.7 Hypochondriasis 300.81 Somatization Disorder 300.82 Somatoform Disorder NOS 300..82 Undifferentiated Somatoform Disorder 300.9 Unspecified Mental Disorder (nonpsychotic) 301.0 Paranoid Personality Disorder 301.13 Cyclothymic Disorder 301..20 Schizoid Personality Disorder 301.22 Schizotypal Personality Disorder 301..4 Obsessive-Compulsive Personality Disorder 301.50 Histrionic Personality Disorder 301.6 Dependent Personality Disorder 301.7 Antisocial Personality Disorder 301.81 Narcissistic Personality Disorder 17

301.82 Avoidant Personality Disorder 301.83 Borderline Personality Disorder 301.9 Personality Disorder NOS 302.2 Pedophilia 302.3 Tranvestic Fetishism 302.4 Exhibitionism 302.6 Gender Identity Disorder in Children 302.6 Gender Identity Disorder NOS 302.70 Sexual Dysfunction NOS 302.71 Hypoactive Sexual Desire Disorder 302.72 Female Sexual Arousal Disorder 302.72 Male Erectile Disorder 302.73 Female Orgasmic Disorder 302.74 Male Orgasmic Disorder 302.76 Dyspareunia (Not due to a General Medical Condition) 302.79 Sexual Aversion Disorder 302.81 Fetishism 302.82 Voyeurism 302.83 Sexual Masochism 302.84 Sexual Sadism 302.85 Gender Identity Disorder in Adolescents or Adults 302.89 Frotteurism 302.9 Paraphilia NOS 302.9 Sexual Disorder NOS 303.90 Alcohol Dependence 304.00 Opioid Dependence 304.10 Sedative, Hypnotic, or Anxiolytic Dependence 304.20 Cocaine Dependence 304.30 Cannabis Dependence 304.40 Amphetamine Dependence 304.50 Hallucinogen Dependence 304.60 Phencyclidine Dependence 304.80 Polysubstance Dependence 304.90 Other (or Unknown) Substance Dependence 305.00 Alcohol Abuse 305.1 Nicotine Dependence 305.20 Cannabis Abuse 305.30 Hallucinogen Abuse 305.40 Sedative, Hypnotic, or Anxiolytic Abuse 305.50 Opioid Abuse 18

305.60 Cocaine Abuse 305.70 Amphetamine Abuse 305.90 Inhalant Abuse 305.90 Other (or Unknown) Substance Abuse 305.90 Phencyclidine Abuse 307.1 Anorexia Nervosa 307.42 Primary Insomnia 307.44 Primary Hypersomnia 307.45 Circadian Rhythm Sleep Disorder 307.46 Sleep Terror Disorder 307.46 Sleepwalking Disorder 307.47 Dyssomnia NOS 307.47 Nightmare Disorder 307.47 Parasomnia 307.50 Eating Disorder NOS 307.51 Bulimia Nervosa 307.52 Pica 307.53 Rumination Disorder 307.59 Feeding Disorder of Infancy or Early Childhood 307.6 Enuresis (Not Due to a General Medical Condition) 307.7 Encopresis, Without Constipation and Overflow Incontinence 307.80 Pain Disorder Associated with Both Psychological Factors and a General Medical Condition 307.9 Communication Disorder NOS 308.3 Acute Stress Disorder 309.0 Adjustment Disorder with Depressed Mood 309.21 Separation Anxiety Disorder 309.24 Adjustment Disorder with Anxiety 309.28 Adjustment Disorder with Mixed Anxiety And Depressed Mood 309.3 Adjustment Disorder with Disturbance of Conduct 309.4 Adjustment Disorder with Mixed Disturbance Of Emotions and Conduct 309.81 Posttraumatic Stress Disorder 309.9 Adjustment Disorder Unspecified 311 Depressive Disorder NOS 312.30 Impulse-Control Disorder NOS 312.31 Pathological Gambling 312.32 Kleptomania 312.33 Pyromania 312.34 Intermittent Explosive Disorder 312.39 Trichotillomania 19

312.81 Conduct Disorder, Childhood-Onset Type 312.82 Conduct Disorder, Adolescent-Onset Type 312.89 Conduct Disorder, Unspecified Onset 312.9 Disruptive Behavior Disorder NOS 313.23 Selective Mutism 313.81 Oppositional Defiant Disorder 313.82 Identity Problem 313.89 Reactive Attachment Disorder of Infancy Or Early Childhood 313.9 Disorder of Infancy, Childhood, or Adolescence NOS 314.00 Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive 314.01 Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive- Impulsive Type 314.9 Attention-Deficit/Hyperactivity Disorder NOS 347 Narcolepsy 20