April 24, 2018

Coding Mental and Behavioral Health Issues

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Achieving accurate and comprehensive coding of such issues is an imperative.

Mental and behavioral disorders have recently had a media spotlight shone on them, and coding of these disorders can sometimes be tricky. Learning the nuances can help achieve accurate coding, which will enhance data necessary to make improvements in coverage, patient care, and engagement.

Mental disorders include a wide variety of problems, including anxiety disorders, phobias, bipolar disorder, depression, personality disorders, etc.

There are many causes to mental disorders. Family history, nurture versus nature, abuse, and biological factors can all contribute. Exposure to viruses or chemicals while pregnant or traumatic brain injuries can also contribute, as well as the use of drugs. Sometimes chronic illness can also play a role in mental disorders due to the stress created by the condition.

Mental disorders contribute to over 65 million physician visits and over 5 million emergency department (as a primary diagnosis) visits annually, according to the Medicare Expenditure Panel Survey (MEPS). These are significant expenditures, and the increases in the need for care have demanded that primary care physicians expand practices to include this specialty.

Recently, HIPAA regulations have provided guidance for providers for patients in danger of harming themselves or others, instructing them to use their expertise and professional judgement when a patient has demonstrated this risk of danger. According to the HIPAA Helps Caregiving Instructions from the Office of Civil Rights (OCR), a health or mental health professional may always share mental health information with a patient’s personal representative, if they have one. They may also contact anyone who is reasonably able to lessen the risk of harm when they believe that a patient presents a serious and imminent threat to the health or safety of a person (including themselves) or the public. This includes notifying a spouse, caregivers, 911, or even law enforcement: https://www.hhs.gov/hipaa/for-professionals/special- topics/mental-health/index.html

The recent headlines regarding the nation’s heroin and opioid abuse epidemic also pertain directly to healthcare. Jaci Kipreos and Caren Swartz recently did a session at AAPC’s national conference covering this exact topic, which is front and center with the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), the American Medical Association (AMA), and Capitol Hill. Many states are creating new laws to monitor the issue. If this is that much on their radar, then coding and reporting becomes a major focus as well.

"The opioid epidemic has affected both the business side of medicine and the clinical,” outgoing AAPC National Advisory President Jaci Kipreos recently said. “For these patients to receive the help they desperately need, the first step is awareness. Then there must be new diagnosis codes to accurately identify the situation and then we must remove the stigma of the diagnosis."

Documentation for mental disorders need to include the type of the condition, the status, what it was caused by or due to, any complications or manifestations, and any co-morbid conditions as well. Mental disorders are treated in all specialties, to some degree. It is important that all providers know how to document these disorders so that the most appropriate codes can be assigned.

Through diligence in reporting, better data can be collected, and new codes can be attributed as needed. Without sufficient data, it is impossible to improve.


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Rhonda Buckholtz, CPC, CPMA, CPC-I, CRC, CDEO, CHPSE, COPC, CPEDC, CGSC

Rhonda Buckholtz has more than 25 years of experience in healthcare, working in the management, reimbursement, billing, and coding sectors, in addition to being an instructor. She was responsible for all ICD-10 training and curriculum at AAPC. She has authored numerous articles for healthcare publications and has spoken at numerous national conferences for AAPC, AMA, HIMSS, AAO-HNS, AGA and ASOA. She is a past co-chair for the WEDI ICD-10 Implementation Workgroup, and current co-chair of the Advanced Payment Models Workgroup and has provided testimony ongoing for ICD-10 and standardization of data for NCVHS. Rhonda is on the board of ICD Monitor and the AAPC National Advisory Board. Rhonda spends her time as chief compliance officer and on practice optimization providing transformational services and revenue integrity for Ophthalmology practices. She was instrumental in developing the Certified Ophthalmology Professional Coder (COPC) exam and curriculum for the AAPC.

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