Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Friday, March 13, 2015

ICD-10 List

Am I missing something about ICD-10? There's a whole lot of fuss about preparing for the transition and testing of systems to see if they comply with the transition. Don't you just need to use a different code? I guess it's more complicated in something like orthopedic surgery, where there's a lot more specificity you can get with ICD-10. And if you use an EMR or some kind of billing system, it needs to generate the new codes. See how it's so much easier not to use an EMR?

Here's a link to ICD-10 Basics. It includes a "Build Your Action Plan" link. I tried it out. It asked for my specialty (Other), how many physicians in my practice (1-2), what technology I used (EHR, which includes ERx), What type of insurance I take (none), and what stage of ICD-10 readiness I'm at (planning).

It gave me this:

Out of curiosity, I tried it again with Orthopedics, 3-6 physicians, EMR/Billing System, Commercial insurance and medicare, and planning stage. It gave me the exact same action plan.

Well, anyway, in preparation for the switch to the ICD-10 coding system this October, or maybe the following one, or the one after that, or some time in the next decade, I decided to smooth the transition for myself by making a list of my most frequently used ICD-9 codes, and converting them to ICD-10 codes via the ICD-9 Diagnosis Converter, which I mentioned in a previous post.

A couple of brief notes:

Only HIPAA covered entities are required to comply with mandatory ICD-10 coding. I'm not a HIPAA covered entity, but I'm going to do it anyway, since it will probably confuse insurance companies if I don't. Or maybe that won't matter because no one will have out of network mental health insurance.

There are two coding systems-ICD-10-CM, and ICD-10-PCS. The difference is that the PCS system is only for inpatient coding.

I currently don't use DSM codes, just ICD-9 ones, so you may need to adjust accordingly. I do this mainly as a form of protest, but also because the ICD system allows for more flexibility in terms of the types of patients I treat. For example, ICD-9 300.4 is Dysthymia, which is the same in DSM. But in ICD-9, Dysthymia includes things like "Depression with Anxiety" and "Neurotic Depressive State"-all billable.

The other point I want to make is that if you have access to DSM-5, you'll notice it includes ICD-10 codes. But I still thought that, at least for myself, it would be helpful to have a simple list of my most commonly used diagnoses, But I also thought I'd add a few more codes that I don't see very frequently, but might be helpful to others.

Finally, it's interesting to note that there's not a direct 1:1 correspondence between DSM-5 diagnoses and ICD-10 diagnoses, and a lot of times, you have to make your best guess. I"m not sure where that leaves DSM-5 in terms of how definitive it believes its diagnoses are.

So, here goes.

In ICD-10, Mental, Developmental, and Neurodevelopmental disorders are coded with an "F" as a prefix, from F01-F99. This is in contrast with Diseases of the Nervous System, which have the prefix, "G". And again, I wonder what implications this distinction has more generally.

There are 10 different sections, from "Mental disorders due to known physiological conditions" to 'Behavioral and emotional disorders with onset usually occurring in childhood and adolescence", plus F99, the meta-vague "Unspecified Mental Disorder".

I'll start with Depressive d/o's:

Note the difference from ICD-9, where the equivalent severity specifiers run from 1 to 4, rather than 0 to 3.

Also note that ICD Dysthymia is different from DSM Dysthymia. It includes the DSM version of Dysthymia, but it extends it:

Clinical Information
  • A term used for any state of depression that is not psychotic
  • Chronic affective disorder characterized by either relatively mild depressive symptoms or marked loss of pleasure in usual activities
  • Chronically depressed mood that occurs for most of the day more days than not for at least 2 years. The required minimum duration in children to make this diagnosis is 1 year. During periods of depressed mood, at least 2 of the following additional symptoms are present: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self esteem, poor concentration or difficulty making decisions, and feelings of hopelessness. (dsm-iv)
  • Depression precipitated by events in a person's life
Applies To
  • Anxiety depression
  • Depression with anxiety
  • Depressive reaction
  • Neurotic depressive state
  • Reactive depression
Disease Synonyms
  • Anxiety associated w depression
  • Anxiety depression
  • Anxiety with depression
  • Depression, reactive
  • Dysthymia
  • Mixed anxiety and depressive disorder
  • Reactive depression
  • Reactive depression (situational)

For the purposes of my practice, this is a really useful diagnostic category, because there's a lot of leeway for depressive symptoms.

Bipolar d/o's:

ICD-10 has a separate heading for Manic Episodes and bipolar D/O.

This is a little fiddly, but Bipolar D/O excludes
* bipolar disorder, single manic episode
* major depressive disorder, single episode
* major depressive disorder, recurrent
* cyclothymia

But it includes
* manic-depressive illness
* manic-depressive psychosis
* manic-depressive reaction

Manic Episode without Psychotic sx is F30.1x,
where x = 0 for unspecifed, 1 for mild, two for moderate, and 3 for moderate without psychotic sx.

This differs from the severity specifiers listed above for MDD.

However, Manic Episode, severe, with psychotic sx has its own code, F30.2

Furthermore, Cyclothymia has a completely separate code, F34.0, and it includes:

* Affective personality disorder
* Cycloid personality
* Cyclothymia, and
* Cyclothymic personality

And more:

Note: Other specified PDD is Asperger's in ICD-10.

And finally, since there are so many different types of substances of abuse, I'm only including Alcohol:

In general, I don't think it matters much what number you put down, except for billing purposes. But it's clear that the ICD system thinks about mental disorders somewhat differently than the DSM does.

Here's a little comic relief to end with. There are some ICD-9  codes that have the same letters and numbers (sometimes with changes in decimal places) as some ICD-10  codes, but mean completely different things. For example,

ICD-9  E802.0 = Railway accident involving derailment without antecedent collision injuring railway employee

ICD-10  E80.20 = Unspecified Porphyria

And finally, finally, if you check the top of the blog, you'll see I've added an additional page, right next to, "Disclaimers," entitled, "ICD-9 to ICD-10 Transition," which is the entire table in one place, albeit a little wonkily, for future reference.