ICD 10 CM Chapter Specific Guidelines I. C5

Dr. Lisa L Campbell®
3 Feb 201906:26
EducationalLearning
32 Likes 10 Comments

TLDRThis informative session reviews ICD-10-CM coding guidelines, focusing on Chapter 5 which addresses mental, behavioral, and neurodevelopmental disorders (F01-F99). It discusses pain disorders related to psychological factors (codes 45.4 and F45.42), substance use disorders in remission, and the distinction between substance abuse and dependence. The session also clarifies the coding for psychoactive substance use unspecified and highlights the specific codes for Munchausen's syndrome and its by proxy variant, emphasizing the importance of provider documentation in accurate coding.

Takeaways
  • 📚 The session focuses on Chapter 5 of ICD-10-CM guidelines, covering mental, behavioral, and neurodevelopmental disorders (code family F01-F99).
  • 🌟 Pain disorders related to psychological factors are discussed, with specific codes 45.4 (pain related to a psychological disorder) and F45.42 (pain disorders with a related psychological factor).
  • 🚫 The 'excludes1' note under category G89 clarifies that G89 should not be assigned with S45.4.
  • 🩺 Clinical judgment is essential in determining if a condition is in remission, with specific guidelines for coding substance use disorders in remission.
  • 📉 In remission codes for mild substance use disorders are classified as 'substance abuse in remission', while moderate or severe cases are coded as 'substance dependence in remission'.
  • 💡 When documentation refers to both use and abuse or dependence, the code for the more severe condition (dependence) should be used.
  • 🛑 For psychoactive substance use, unspecified, reliance on the provider's documentation is crucial and these conditions should only be reported when associated with a diagnosable physical, mental, or behavioral disorder.
  • 🎯 The code F60.8 is used for Munchausen's syndrome, where a person falsely reports or causes their own physical or physiological signs or symptoms.
  • 🔍 Munchausen's syndrome by proxy (F60.8) involves a caregiver falsely reporting or causing illness or injury to another person under their care.
  • 📌 Codes from the T74 category are used for confirmed cases of abuse or neglect, while T76 is used for suspected cases.
  • 📈 The session concludes with an encouragement to return for the next chapter-specific guideline coding review.
Q & A

  • What is the focus of Chapter 5 in the ICD-10-CM guidelines?

    -Chapter 5 of the ICD-10-CM guidelines focuses on mental, behavioral, and neurodevelopmental disorders, which falls under the code family of F01 through F99.

  • What are the two codes of concern related to pain disorders caused by psychological factors?

    -The two codes of concern are 45.4, used for pain exclusively related to a psychological disorder, and F45.42, used for pain disorders with a related psychological factor.

  • What does the 'excludes1' note under category G89 indicate?

    -The 'excludes1' note under category G89 indicates that G89 should not be assigned with S45.4.

  • How is the status of 'in remission' determined in reporting ICD-10-CM codes for mental and behavioral disorders due to psychoactive substance use?

    -The status of 'in remission' is determined based on the provider's clinical judgment as to whether or not a condition is in fact in remission.

  • What are the coding guidelines for substance use disorders in remission?

    -Mild substance use disorders in early or sustained remission are coded to substance abuse in remission, while moderate or severe substance use disorders in early or sustained remission are coded to substance dependence in remission.

  • When should only one code be reported for substance use and dependence of the same substance?

    -Only one code should be reported when the provider documentation refers to use, abuse, and dependence of the same substance, with the code depending on whether the documentation specifies abuse or dependence.

  • What are the requirements for reporting psychoactive substance use, unspecified?

    -Psychoactive substance use, unspecified should be reported only when it is associated with a physical, mental, or behavioral disorder, and the relationship has to be documented by the provider.

  • What is the ICD-10-CM code for Munchausen's syndrome?

    -The ICD-10-CM code for Munchausen's syndrome is F60.8.

  • What is Munchausen's syndrome by proxy, and how is it coded?

    -Munchausen's syndrome by proxy is when a caregiver falsely reports or causes an illness or injury in another person under their care. It is coded as F60.8 for the perpetrator and T76 for suspected cases, while confirmed cases involve the T74 category.

  • What is the difference between T74 and T76 codes in the context of abuse and neglect?

    -T74 is used for confirmed cases of adult and child abuse, neglect, and other maltreatment, while T76 is used for suspected cases.

  • How does the speaker describe their initial reaction to the guidelines for substance use abuse and dependence?

    -The speaker initially found the guidelines for substance use abuse and dependence confusing due to the complexity and the number of considerations involved.

Outlines
00:00
📚 ICD-10-CM Coding Guidelines: Mental, Behavioral, and Neurodevelopmental Disorders

This paragraph discusses the ICD-10-CM coding guidelines for chapter 5, which focuses on mental, behavioral, and neurodevelopmental disorders (code family F01-F99). It highlights two specific codes related to pain disorders influenced by psychological factors: 45.4 for pain solely related to a psychological disorder, and F45.42 for pain disorders with a related psychological factor. The paragraph emphasizes the importance of clinical judgment in determining whether a condition is in remission and provides guidelines for coding substance use disorders in remission. It also addresses the coding of substance use abuse and dependence, with a clear explanation of how to report these when the provider documentation refers to both. Lastly, the paragraph touches on the coding of psychoactive substance use, unspecified, and introduces the fictitious disorder (Munchausen's syndrome) and its syndrome by proxy, with the appropriate codes to be used for each.

05:00
📝 Understanding Fictitious Disorders and Coding in Remission

This paragraph delves into the specifics of coding for fictitious disorders, such as Munchausen's syndrome (code F60.8), and its by proxy variant (code F60.8), where a caregiver falsely induces illness or injury in another person under their care. It contrasts this with confirmed and suspected cases of abuse or neglect (codes T74 and T76, respectively). The paragraph concludes by encouraging listeners to return for the next chapter-specific guideline coding review, reinforcing the importance of accurate and informed coding practices.

Mindmap
Keywords
💡ICD-10-CM
The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is a coding system used by healthcare professionals to classify diagnoses and procedures for billing and statistical purposes. In the video, ICD-10-CM coding guidelines are reviewed, specifically focusing on chapter 5 which deals with mental, behavioral, and neurodevelopmental disorders.
💡Mental Behavioral and Neurodevelopmental Disorders
These are a broad category of conditions that affect an individual's thinking, emotion, and social behavior. They include a range of disorders from autism and ADHD to schizophrenia and mood disorders. The video's focus is on the ICD-10-CM coding guidelines for these types of disorders.
💡Pain Disorders
Pain disorders related to psychological factors are conditions where the experience of pain is linked to psychological or emotional issues. These disorders are distinct from physiological pain caused by injury or disease. The video discusses specific ICD-10-CM codes for such disorders.
💡Psychoactive Substance Use
This term refers to the use of substances that affect the mind and behavior, altering perceptions, mood, consciousness, or behavior. The video discusses the ICD-10-CM coding for mental and behavioral disorders due to psychoactive substance use, including the criteria for 'in remission' status.
💡Clinical Judgment
Clinical judgment refers to the healthcare provider's professional assessment and decision-making based on patient examination, diagnosis, and treatment. In the context of the video, it is essential for determining whether a condition is in remission or for accurately coding psychoactive substance use disorders.
💡Substance Use Abuse and Dependence
These terms describe the problematic use of substances, with abuse referring to harmful patterns of use that do not necessarily involve physical dependence, while dependence indicates a more severe condition with both psychological and physical reliance on the substance. The video clarifies the coding guidelines for these conditions.
💡Unspecified Psychoactive Substance Use
This term refers to a condition where the specific psychoactive substance used is not detailed, and the focus is on the impact of the substance use on the individual's physical, mental, or behavioral health. The video emphasizes that these codes should only be used when a reportable diagnosis is met and the relationship between substance use and the disorder is documented by the provider.
💡Fictitious Disorder
Also known as Munchausen's syndrome, this is a condition where an individual falsely reports or induces symptoms or signs of illness in themselves. It is a form of factitious disorder that involves self-harm for the purpose of assuming a sick role.
💡Munchausen's Syndrome by Proxy
This is a form of factitious disorder where a caregiver, often a parent, fabricates or induces illness in someone under their care, typically a child. It is a serious form of abuse where the victim is subjected to unnecessary medical procedures and potential harm.
💡Adult and Child Abuse Neglect
This term encompasses the mistreatment or endangerment of adults and children, which can include physical, emotional, or sexual abuse, as well as neglect. The video discusses the use of specific ICD-10-CM codes to indicate confirmed or suspected cases of abuse or neglect.
Highlights

Today's review focuses on Chapter 5 of ICD-10-CM guidelines related to mental, behavioral, and neurodevelopmental disorders.

The code family for this chapter ranges from F01 through F99.

Two codes of concern for pain disorders related to psychological factors are 45.4 and F45.42.

An 'excludes1' note under category G89 indicates that G89 should not be assigned with S45.4.

For acute or chronic pain without a psychological component, the appropriate code is not specified.

Mental and behavioral disorders due to psychoactive substance use are discussed, with a focus on 'in remission' reporting.

Clinical judgment is required to determine if a condition is in remission.

Mild substance use disorders in remission are coded as substance abuse in remission.

Moderate or severe substance use disorders in remission are coded as substance dependence in remission.

When documentation refers to use, abuse, and dependence of the same substance, only one code is reported based on the provider's documentation.

Psychoactive substance use, unspecified, should only be reported when associated with a physical, mental, or behavioral disorder.

Unspecified codes are used only when the relationship between substance use and the disorder is documented by the provider.

Fictitious disorder, also known as Munchausen's syndrome, is characterized by falsely reporting or causing physical or physiological signs or symptoms.

Code F60.8 is used for Munchausen's syndrome.

Munchausen's syndrome by proxy involves a caregiver falsely reporting or causing illness or injury in another person under their care.

Code F60.8 is used for the person with Munchausen's syndrome by proxy, while T74 category codes are used for the victim.

T74 category includes codes for adult and child abuse, neglect, and other maltreatment, with T76 for suspected cases.

The review emphasizes the importance of provider documentation in determining the appropriate ICD-10-CM codes for substance use and related disorders.

Transcripts

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ICD-10-CMCoding GuidelinesMental DisordersPain ManagementSubstance AbuseMunchausen SyndromeHealthcare ComplianceClinical DocumentationMedical BillingHealthcare Professionals