Coding Considerations for Suicide

September is the annual Suicide Prevention Month which is also a reminder to examine our coding considerations.  

In March of this year, the Centers for Disease Control and Prevention (CDC) published data for 2023.  Sadly, it noted over 49,000 people died by suicide in 2023.  They further noted the significance of that statistic: one suicide death every 11 minutes. 

The March 26 article noted other sobering statistics:  12.8 million people seriously thought about suicide, with 3.7 million people making a plan for suicide.  1.5 million people in 2023 attempted suicide.  It also noted a rise in the suicide rate from the year 2000 through 2018 with a 5% decrease in the following two years. 

Sadly again, the rates returned to their peak in 2022.   Looking at some of the demographic information they presented it noted that in 2023 the suicide rate for men was about four times higher than for women.  This means that while men make up about half of the total population, they account for about 80 percent of the suicides.  Finally, it noted the age group with the highest rate of suicide in 2023 were those 85 years old and older. 

The American Foundation for Suicide Prevention led an effort to work with other mental health agencies, non-profit organizations and partners in Congress to establish 988 as the Suicide and Crisis Lifeline.  Prior to July 2022, someone needed to call a 1-800 number for help.  988 is now the three digit hotline for suicide prevention as well as other mental health and substance use crises.  This number is available anywhere in the United States linking the caller to immediate crisis care. 

The goal of 988 was to provide an effective alternative to calling 911 when experiencing a mental health crisis. 

Looking at our coding, from the Alphabetic Index, there is an entry for Suicide, suicidal with the non- essential modifier of attempted in parentheses.  Code T14.91 is noted for Suicide attempt which includes Attempted suicide NOS.  When assigning T14.91 we would add 7^th characters A, D or S for the appropriate episode of care.  Back to the Alphabetic Index, if the suicide was due to a poisoning we are instructed to see the Table of Drugs and Chemicals.  We would then assign the specific drug or chemical used with a code from the Poisoning, Intentional self-harm column.  If the suicide was by trauma we are instructed to see nature of injury by site. 

Suicidal risk or tendencies meaning personal history of attempted suicide would be assigned to Z91.51, Personal history of suicidal behavior.  Included here is personal history of parasuicide, personal history of self-poisoning, as well as personal history of suicide attempt.  If the suicidal risk or tendencies are meaning suicidal ideation we are instructed to see Ideation, suicidal which takes us to R45.851, Suicidal ideations. 

Code R45.851 is considered a CC condition. 

There is also a code for history of suicide attempt in family, code Z81.8 Family history of other mental and behavioral disorders. 

Finally, if you know someone who is struggling with their mental health please make sure, they aware of the 988 Suicide and Crisis Lifeline.