Enhancing Your Mental Health Coding

May is National Mental Health Awareness Month, making it a good time to check out the National Institute of Mental Health (NIMH) digital toolkit on the topic.

In our own way of marking Mental Health Awareness Month, here is a review of the February updated ICD-10-CM Coding and Reporting Guidelines, Chapter 5 (Mental, Behavioral, and Neurodevelopmental Disorders) for the 2024 fiscal year:

• Pain disorders related to psychological factors:
  • Assign F45.41 for pain exclusively related to psychological factors.
  • Assign F45.42 for pain disorders with related psychological factors with a code from category G89 (Pain, Not Elsewhere Classified).

• Mental and behavioral disorders due to psychological substance abuse:
  • “In remission” requires the provider’s clinical judgement and is only assigned based on provider documentation.
  • When the provider documents use, abuse, and dependence of the same substance, only assign one code based on the hierarchy of use, abuse, and dependence with, dependence the highest in the hierarchy.
  • Psychoactive substance use, unspecified should only be reported when it meets the definition of a reportable diagnosis. Remember that there is a Medicare Code Edit for unspecified diagnosis codes.
  • Medical conditions due to substance use, abuse, and dependence are not classified as substance-induced disorders. Assign the diagnosis code for the medical condition as directed by the Alphabetical Index.
  • Blood-alcohol level (Y90.-) is only reportable when there is a reportable diagnosis from category F10 (Alcohol-related disorders).

• Factitious disorders imposed on self or Munchausen’s syndrome is a disorder in which a person falsely reports or causes his or her own physical or psychological signs or symptoms. Categories T74 (Adult or child abuse, confirmed) or T76 (Adult or child abuse, suspected) may also be reported.

• Dementia has categories F01, F02, and F03, which classify dementia based on severity and etiology. Selection of the appropriate code is based on the provider’s clinical documentation. If the patient’s severity level progresses to a higher severity level during the stay, then only assign one code for the highest severity level.

It is important to also review the coding instructions throughout this chapter. Dementia categories F01 and F02 have instructions to code another condition first. There are also instructions to use additional codes that fully report the patient’s condition.

Category F84 (Pervasive developmental disorders) has the instruction to also code any associated medical conditions and intellectual disabilities.

Wishing everyone good mental health!

Resources:

https://www.nimh.nih.gov/get-involved/digital-shareables

FY2024 ICD-10-CM Coding and Reporting Guidelines, Chapter 5

2024 April 1-ICD-10-CM Guidelines (cms.gov)