ICD-10 Codes Amid the Pandemic and the U.S. Election

The mood of the country impacts claims.

There are a few words that can be associated with the pandemic and the election. These words are the following:

• Stress – a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances

• Anxiety – a feeling of worry, nervousness, or unease typically about an imminent event or something with an uncertain outcome

• Depression – feelings of severe despondence and dejection

These definitions are from Webster’s Dictionary, not Diagnostic and Statistical Manual of Mental Disorders, 5^th Revision (DSM5) and certainly describe the mood of the country.   There are various codes associated with these conditions.

There are more codes for depression with specific descriptors.    A physician query can be issued to obtain a more specific code.

The diagnosis codes that fall between Z55 – Z65 are considered to be Social Determinants of Health (SDoH).   These codes have not been assigned often but are utilized in population health data.  This data has been utilized by payers and other organizations to create social programs have developed during the pandemic.

There are some behavioral health codes that can affect reimbursement when they have specificity.   Bipolar disorder, major depressive disorder, and specified mood disorders are considered comorbid/complications (CCs) under Inpatient Prospective Payment System (IPPS).

A physician query that clarifies the diagnosis regarding the acuity and type may identify a condition that impacts reimbursement.

The diagnosis (and procedure) codes should tell a story about the patient’s condition and experience.

The current mood of the country will add more of these codes to the patient claims.

Programming Note: Laurie Johnson is a permanent panelist on Talk Ten Tuesdays. Listen to her live reporting on ICD-10 codes every Tuesday at 10 a.m. EST.