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:
These definitions are from Webster’s Dictionary, not Diagnostic and Statistical Manual of Mental Disorders, 5th Revision (DSM5) and certainly describe the mood of the country. There are various codes associated with these conditions.
| Terms | Subterms | ICD-10-CM Code |
| Stress | (default) | F43.9 |
| Work related | Z56.6 | |
| Work schedule | Z56.3 | |
| Family due to stressful life events | Z63.79 | |
| Anxiety | (default) | F41.9 |
| Depression | F41.8 | |
| Generalized | F41.1 | |
| Panic type | F41.0 | |
| Depression | (default) | F32.9 |
| Agitated | F32.2 | |
| Neurotic | F34.1 | |
| Major with psychotic symptoms | F32.3 | |
| Mild, single, episode | F32.0 | |
| Persistent | F34.1 | |
| Recurrent with psychotic features | F33.3 |
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.
I had planned a different topic for this week, sequencing sepsis, based on feedback from my last article, but an article about OpenEvidence rolling out
EDITOR’S NOTE: The author of this article used artificial intelligence (AI)-assisted tools in its composition, but all content, analysis, and conclusions were based on the
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