The recently implemented 2018 ICD-10 codes affect many different areas of diagnoses, including mental, behavioral and neurodevelopmental disorders, which is the focus of Chapter 5. With these changes, more accurate diagnostic recording will be experienced. In our continuing series on the 2018 ICD-10 code updates, we will focus this blog on the changes that impacted Chapter 5.
Alzheimer’s disease, which causes the decline in mental and physical function is the most common cause of mental deterioration. More than five million people in the US are affected by Alzheimer’s, and it is now the sixth leading cause of death in America. In 2017, this disease alone cost the nation $259 billion, but by 2050 it is expected to be a $1.1 trillion issue.
The coding for this widespread disease was impacted by the 2018 ICD-10 coding instructional changes. The G30 code is used for Alzheimer’s. Alzheimer’s is the most common form of dementia, and dementia is inherent in the Alzheimer’s diagnosis. Dementia does not have to be documented by a physician to be coded with Alzheimer’s. You should use the F02 code with Alzheimer’s to further define the dementia. The F02 code is a manifestation code and is never used alone.
Specific Alzheimer’s Case
Below is a specific case related to Alzheimer’s and proper coding:
An 80-year-old patient is admitted to home health with diagnosis of late onset Alzheimer’s. The referral states the patient is starting to wander, and does not recognize where he is or how he got there. Also, he is sometimes hostile with his spouse and does not seem to recognize her at times. The patient has CHF (which is exacerbated and the focus of the home health episode) with bibasilar crackles with productive frothy cough and lower extremity +2 edema, CAD and essential HTN. BP has fluctuated since the symptoms of CHF have worsened. The home health order is for SN for Cg instruction and assessment of CHF disease process, Alzheimer’s education and MSW for resource education and support. SN frequency is 3wk1, 2wk2. MSW is 2mo1.
M1021 I50.9 Heart Failure Unspecified
M1023 I10 Hypertension, essential
M1023 I25.10 Atherosclerotic heart disease of native coronary arteries without angina pectoris
M1023 G30.1 Late onset Alzheimer’s
M1023 F02.81 Dementia with behavior disturbance
M1023 R45.5 Hostility
M1023 Z91.83 Wandering in diseases classified elsewhere
In this example, the focus of care and diagnosis requiring the most number of visits is the CHF so it is coded as primary. Hypertension is exacerbated and CAD is coded as a comorbidity as it contributes to the cardiac issues the patient is experiencing. The Alzheimer’s is coded as G30.1, which is late onset (due to the patient’s age). This code is more specific. Dementia is coded even though it is not mentioned specifically as it is inherent to Alzheimer’s. The patient has a behavior problem associated with the dementia so the Z91.83 code is used. Wandering is considered a behavior problem when coding dementia, but is not inherent to dementia; therefore, it is coded. There are certain R45 codes you could use to describe behaviors the patient with dementia has. These should be used if they help to better describe the patient and support increased LOS or visits. Any time you use a symptom code it must follow the definitive or causal diagnosis code.
New Addiction Remission Codes
Seven of the new 2018 ICD-10 codes are related to addiction remission. These codes are related to categories F10-F19. The physician must document that the patient is in remission. Mental and behavioral disorders due to psychoactive substance use (categories F10-F19 with -11, -.21) require the provider’s clinical judgment. The appropriate codes for “in remission” are assigned only on the basis of provider documentation (as defined in the Official Guidelines for Coding and Reporting), unless otherwise instructed by the classification.
There are codes for use, abuse and dependence, but you only code one. If the physician documentation states all—use, abuse and dependence of the same substance then you code for dependence. If abuse is documented, the patient has an intense desire to use a substance in increasing amounts to the exclusion of all other activities, but is not dependent. If a patient is categorized as dependent then the user has a physical need and suffers withdrawal if the substance is not available.
Mild substance use disorders in early or sustained remission are classified to the appropriate codes for substance abuse in remission. Moderate or severe substance use disorders in early or sustained remission are classified to the appropriate codes for substance dependence in remission.
Specific Addiction Case
Below is a specific example related to addiction and proper coding:
A patient is admitted for wound care related to facial lacerations to the forehead and cheek, which were sustained in an auto accident. He was driving under the influence of alcohol, veered off the roadway and struck a tree. He was arrested since this was his third DUI. The physician states the patient has a severe dependence on alcohol, along with a sleep disturbance and a bipolar disorder, which are both related to alcohol use.
M1021 S01.80XD Laceration without foreign body of other part of head
M1023 S01.411D Laceration without foreign body right cheek and temporomandibular area
M1023 F10.24 Alcohol dependence with alcohol induced mood disorder
M1023 F10.282 Alcohol dependence with alcohol induced sleep disorder
M1023 V47.0XXD Car driver injured in collision with fixed or stationary object in nontraffic accident (optional)
The lacerations are the focus of care so they are coded first. The alcohol dependence and alcohol induced conditions will impact the POC so they are coded also. The V code or external cause code is voluntary and does not need to be coded. If the agency chooses to include external cause codes, the codes for place of encounter are not coded in home health, only for initial encounter coding.
Avoidant / Restrictive Food Intake Disorder
Eating disorders are a major issue with at least 30 million people of all ages and genders in the U.S. Every 62 minutes at least one person dies as a direct result from an eating disorder, which translates into the highest mortality rate of any mental illness. The 2018 ICD-10 code changes deal with avoidant/restrictive food intake disorder (ARFID), which was previously known as selective eating disorder (SED). Now it is designated by code-F50.82. This is an eating as well as a feeding disorder. The consumption of certain foods is limited based on the food’s appearance, smell, taste, texture, brand, presentation, or a past negative experience with the food.
Symptoms of ARFID are usually found in conjunction with symptoms of other disorders such as obsessive-compulsive and autism. Although many people with ARFID have symptoms of these disorders, they usually do not qualify for a full diagnosis. However, some form of feeding disorder is found in 80 percent of children that also have a developmental disability.
ARFID can also be considered an anxiety disorder. Specific food avoidances could be caused by food phobias. Great anxiety may result when a person is presented with these new or feared foods. Those who suffer from ARFID do not have a fear of gaining weight, but the psychological symptoms and anxiety created are similar.
The team at 5 Star can help to guarantee success regarding the 2018 ICD-10 coding changes. Whether your in-house staff needs training on these coding updates or you are in need of outsourced coders, our highly skilled team of certified, experienced RN coders can help. For further information regarding our coding services and training options, please contact us at [email protected] or 866-428-4040.