Within this chapter there are a variety of code blocks grouping mental disorders together and covering the following:
- Mental disorders due to known physiological conditions;
- Mental and behavioral disorders due to psychoactive substance use;
- Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders;
- Mood (affective) disorders;
- Anxiety, dissociative, stress-related, somatoform, and other nonpsychotic mental disorders;
- Behavioral syndromes associated with physiological disturbances and physical factors;
- Disorders of adult personality and behavior;
- Intellectual disabilities;
- Pervasive and specific developmental disorders;
- Behavioral and emotional disorders with onset usually occurring in childhood and adolescence; and
- Unspecified mental disorder.
In the category of “mood disorders,” code range F30-F39, you’ll find conditions such as manic episode, bipolar disorder, major depressive disorder, and persistent mood disorders.
Clinical documentation is the foundational link to the coded data, as with ICD-9 and CPT today. For example, within ICD-10-CM the documentation of a major depressive disorder should specify or include the following information, if known:
- Single episode versus recurrent
- Mild, moderate, or severe
- With or without psychotic features
- In partial or full remission
The ICD-10 classification allows for better data capture in the area of major depressive disorders through greater specificity. Certainly this provides advantages to those in the fields of mental health medicine and research.
Alcohol- and drug-related disorders (i.e. substance abuse and dependence) are found in this chapter also.
Selection of codes for “in remission” for code categories F10-F19, Mental and behavioral disorders due to psychoactive substance use, requires the provider’s clinical judgment and documentation to support the code(s). A history of alcohol or drug dependence is classified as “remission” in ICD-10-CM.
Capturing quality healthcare data will bring value to treatment, research, and prevention. In addition, it will assist and improve public health surveillance efforts, including those in the area of mental health. As we continue down the path toward ICD-10 implementation in October 2015, we need to dedicate time and effort to education and training centering on the code set in order to be successful.
A key component of this will be ensuring that we include in our implementation journey awareness of documentation specifics to enhance our nation’s healthcare data and ultimately improve the quality of patient care.
