February 23, 2015

A Code for the Season

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With all of the recent snow and bad weather spreading across the country, there is a disorder that may be affecting you, your friends and family, or some of your coworkers. It’s called seasonal affective disorder (SAD).

Many of you who, like I, live in the sunny southern states, may not be familiar with SAD; however, our friends up north all know the toll a long, cold winter can have not only on you physically, but mentally as well. 

What is SAD? It is a psychological condition that is normally brought on by seasonal changes that result in depression. It is most common in women as well as adolescents and young adults. The exact cause is unknown, and contributing factors vary between individuals. However, people who live in parts of the country that have long winter nights and less sunlight are more prone to SAD.

One theory is that decreased sunlight exposure affects the natural biological clock that regulates hormones, sleep, and moods. In addition, people who have a history of psychosocial conditions are at greater risk of developing SAD.

SAD is treated with counseling and therapy. Wintertime SAD can also be treated with light therapy, in which a specialized light box or visor is used for at least 30 minutes each cay to replicate natural light. Light therapy should be used only under a physician’s supervision and with approved devices. Other light-emitting sources, such as tanning beds, are not safe for use. Some patients may also benefit from medications such as antidepressants. Healthy lifestyle habits, such as a healthy diet, exercise, and regular sleep, can also help minimize SAD symptoms.

As a coder who has spent her professional career living and working in Florida, coding SAD was not something I was familiar with, but I love a challenge. I wondered if ICD-10-CM, with all of its specificity, had a code for SAD. My training told me to go to the index first and look under “disorder.” There was nothing there for seasonal affective disorder, so I turned to the coder’s best friend, Google, to learn more. What I found, as stated above, is that SAD is a form of depression. So back to the ICD-10-CM index I went to find depression, and there “depression- seasonal” directed me to “see disorder, depressive, recurrent.”  

 

Next in the index, I found disorder, depressive, recurrent, which led me to the default code of F32.9. I would be reluctant to code depression without the physician specifically stating “depression” in his or her note. This would be a query opportunity to ensure that the patient truly has depression. 

If my physician documents SAD with depression, good documentation will allow me to code to the level of severity: mild, moderate, or severe, as well as with or without psychotic symptoms. Note there are also codes for patients who may be in full or partial remission. It will be the physician’s documentation that will allow you to code this to the highest level of specificity.

 

When a definitive diagnosis has not been made, it is appropriate to code signs and symptoms. Symptoms of wintertime SAD include:

  • Fatigue – R53.83
  • Difficulty concentrating – R41.840
  • Feelings of hopelessness and lack of interest in social activities – R45.89
  • Increased irritability – R45.4
  • Lethargy – R53.83
  • Reduced sexual interest – R68.82
  • Unhappiness – R45.2
  • Weight gain – R63.5

The symptoms of SAD can mirror those of several other conditions, such as bipolar disorder, hypothyroidism, and mononucleosis; therefore, the physician’s documentation of a definitive diagnosis is the key to correctly coding SAD. 

About the Author

Kathy Pride, CPC, RHIT, CCS-P, is vice president of professional services for Panacea Healthcare Solutions. Kathy has extensive experience in management, project implementation, coding, billing, physician documentation improvement, compliance audits and education. She is also an approved ICD-10 Trainer through the American Health Information Management Association (AHIMA) and a previous member of the AAPC National Advisory Board (1998 – 2000).

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Kathy Pride, CPC, RHIT, CCS-P, AHIMA-Approved ICD-10-CM/PCS Trainer

Kathy is a proven leader in healthcare revenue cycle management with extensive experience in management, project implementation, coding, billing, physician documentation improvement, compliance audits, and education. She has trained and managed Health Information Management (HIM) professionals in multiple environments. She is currently the Senior Vice President of Coding and Documentation Services for Panacea Healthcare Solutions. Kathy has provided compliance auditing and documentation education to hundreds of physicians and coders throughout her career.