Mental Health and Substance Abuse

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UHS, Inc. ICD-10-CM/PCS Physician Education
Mental Health and Substance Abuse
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ICD-10 Implementation

• October 1, 2015 Compliance date for
  implementation of ICD-10-CM (diagnoses) and
  ICD-10-PCS (procedures)
• Ambulatory and physician services provided on or
  after 10/1/15
• Inpatient discharges occurring on or after
  10/1/15
• ICD-10-CM (diagnoses) will be used by all
  providers in every health care setting
• ICD-10-PCS (procedures) will be used only for
  hospital claims for inpatient hospital procedures
  
• ICD-10-PCS will not be used on physician claims,
  even those for inpatient visits

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Why ICD-10

• Current ICD-9 Code Set is
• Outdated 30 years old
• Current code structure limits amount of new codes
  that can be created
• Has obsolete groupings of disease families
• Lacks specificity and detail to support
• Accurate anatomical positions
• Differentiation of risk severity
• Key parameters to differentiate disease
  manifestations

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Diagnosis Code Structure
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ICD-10-CM Diagnosis Code Format
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Comparison ICD-9 to ICD-10-CM
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Procedure Code Structure
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ICD-10-PCS Code Format
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ICD-10 Changes Everything!

• ICD-10 is a Business Function Change, not just
  another code set change.
• ICD-10 Implementation will impact everyone
• Registration, Nurses, Managers, Lab, Clinical
  Areas, Billing, Physicians, and Coding
• How is ICD-10 going to change what you do?

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ICD-10-CM/PCS Documentation Tips
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ICD-10 Provider Impact

• Clinical documentation is the foundation of
  successful ICD-10 Implementation
• Golden Rule of Documentation
• If it isnt documented by the physician, it
  didnt happen
• If it didnt happen, it cant be billed
• The purpose in documentation is to tell the story
  of what was performed and what is diagnosed
  accurately and thoroughly reflecting the
  condition of the patient
• what services were rendered and what is the
  severity of illness
• The key word is SPECIFICITY
• Granularity
• Laterality
• Complete and concise documentation allows for
  accurate coding and reimbursement

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Gold Standard Documentation Practices

1. Always document diagnoses that contributed to the
   reason for admission, not just the presenting
   symptoms
2. Document diagnoses, rather that descriptors
3. Indicate acuity/severity of all diagnoses
4. Link all diseases/diagnoses to their underlying
   cause
5. Indicate suspected, possible, or likely
   when treating a condition empirically
6. Use supporting documentation from the dietician /
   wound care to accurately document nutritional
   disorders and pressure ulcers
7. Clarify diagnoses that are present on admission
8. Clearly indicate what has been ruled out
9. Avoid the use of arrows and symbols
10. Clarify the significance of diagnostic tests

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ICD-10 Provider Impact

• The 7 Key Documentation Elements
• Acuity acute versus chronic
• Site be as specific as possible
• Laterality right, left, bilateral for paired
  organs and anatomic sites
• Etiology causative disease or contributory
  drug, chemical, or non-medicinal substance
• Manifestations any other associated conditions
• External Cause of Injury circumstances of the
  injury or accident and the place of occurrence
• Signs Symptoms clarify if related to a
  specific condition or disease process

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ICD-10 Documentation Tips

• Do not use symbols to indicate a disease.
• For example ?lipids means that a laboratory
  result indicates the lipids are elevated
• or ?BP means that a blood pressure reading is
  high
• These are not the same as hyperlipidemia or
  hypertension

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ICD-10 Documentation Tips

• Site and Laterality right versus left
• bilateral body parts or paired organs
• Example cellulitis of right upper arm
• Stage of disease
• Acute, Chronic
• Intermittent, Recurrent, Transient, Persistent
• Primary, Secondary
• Stage I, II, III, IV

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ICD-10 Documentation Tips

• Status of disease
• Mild
• Moderate
• Severe
• Major
• In remission, Not in remission
• Single episode, Recurrent major
• Link manifestations with a mental or behavioral
  disorder
• Speech impediment with autism
• Identify disease related to behavioral disorder
• Alzheimers with aggressive behavior

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ICD-10 Documentation Tips

• Mental disorders due to physiologic condition
• Document associated conditions
• Personality and behavior disorders due to
  physiological condition
• Specify the physiological condition
• List underlying physiological condition
• Specify if dementia is with / in underlying
  condition
• Clearly identify any associated alcohol or
  psychoactive substance use / disorders
• Any behavior disturbances?

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ICD-10 Documentation Tips

• Mood Disorders
• Most recent episode
• Depressed
• Manic
• Mixed
• Acuity
• Mild
• Moderate
• Severe
• Status
• Partial remission
• Full remission
• Episode of care
• Single or recurrent

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ICD-10 Documentation Tips

• Non-Psychotic Mental Disorders
• Type
• Anxiety
• Dissociative
• Stress-related
• Somatoform
• Acuity
• Mild, Moderate, Severe
• Status
• With or without panic attacks
• Conversion disorders
• List symptoms seizures, motor deficit

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ICD-10 Documentation Tips

• Non-Psychotic Mental Disorders continued
• Somatoform
• Specify disorder hypochondriacal disorders,
  pain disorders
• Specify type of phobia
• PTSD acute or chronic
• OCD specificity
• Obsessive-compulsive personality depression
• Obsessive compulsive disorder
• Schizophrenia
• Link and manifestations or related conditions
• Depressed mood
• Conduct disturbance
• Mixed emotion disturbance

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ICD-10 Documentation Tips

• Physical Factors
• Type
• Eating disorder
• Sleep disorder
• Sexual dysfunction
• Postpartum depression
• Specify type be as specific as possible
• Eating Disorder
• Specify type and binge eating / purging
• Document any associated mental or adjustment
  disorder

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ICD-10 Documentation Tips

• Intellectual Disability
• Specify the Type
• Acuity
• Mild
• Moderate
• Severe
• Profound
• Document associated physical or developmental
  disorders

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ICD-10 Documentation Tips

• Schizophrenia
• Type
• Schizophrenia
• Schizoaffective disorder
• Schizophrenic reaction
• Schizotypal disorder
• Document associated conditions
• Aspergers
• Epilepsy
• Brain disease
• Alcoholism
• Identify any
• Acute schizophrenic-like psychotic disorders
• Post schizophrenic depression

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ICD-10 Documentation Tips

• Childhood / Adolescent
• Type of conduct disorder
• Childhood-onset
• Adolescent-onset
• Confined to family context
• Oppositional defiant disorder
• Type of social functioning disorder
• Selective mutism
• Reactive attachment disorder
• Disinherited attachment disorder
• Type of ADHD
• Inactive
• Hyperactive
• Combined

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ICD-10 Documentation Tips

• Childhood / Adolescent continued
• Manifestations / related conditions
• ADHD
• Mood disorders
• Emotional disorders
• Pervasive developmental disorders
• Schizophrenia
• Separation anxiety
• Failure to thrive
• Growth retardation
• Aspergers syndrome
• Tic disorders with specific type

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ICD-10 Documentation Tips

• Adult Personality Disorders
• Type
• Paranoid
• Schizoid
• Antisocial
• Borderline
• Histrionic
• Obsessive-compulsive
• Avoidant
• Dependent
• Narcissistic
• Manifestations / related conditions
• Other mental disorders
• Alcohol or substance use
• Impulse disorders

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ICD-10 Documentation Tips

• Drug and Alcohol Use
• Expanded code set to classify cause-and-effect
  indicators
• Specify drug used
• Document intoxication and blood alcohol levels
• Documentation requirements include
• Specific aspects of the effects
• Example use, abuse, or dependence
• Specify the aspects of use
• Example withdrawal state, in remission
• Identify manifestations / alcohol or drug-induced
  disorders
• See next slide for examples

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ICD-10 Documentation Tips

• Drug and Alcohol Use
• Conditions associated with Withdrawal Syndromes
• Delirium
• Tremors
• Mood or psychotic disorder
• Perceptual disturbance
• Amnesic disorder or dementia
• Anxiety
• Sleep disorder
• Conditions associated with Alcohol Drug-induced
  psychotic disorder
• Delusions
• Hallucinations
• Anxiety
• Sexual dysfunction
• Sleep disorder

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ICD-10 Documentation Tips

• Drug Under-dosing is a new code in ICD-10-CM.
• It identifies situations in which a patient has
  taken less of a medication than prescribed by the
  physician.
• Intentional versus unintentional
• Documentation requirements include
• The medical condition
• The patients reason for not taking the
  medication
• example financial reason
• Z91.120 Patients intentional underdosing of
  medication due to financial hardship

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ICD-10 Documentation Tips

• ICD-10-PCS does not allow for unspecified
  procedures, clearly document
• Body System
• general physiological system / anatomic region
• Root Operation
• objective of the procedure
• Body Part
• specific anatomical site
• Approach
• technique used to reach the site of the
  procedure
• Device
• Devices left at the operative site

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ICD-10 Documentation Tips

• Most Common Root Operations

Detoxification - from alcohol /or drugs
Electroconvulsive Therapy application of controlled electrical voltages to treat a mental health disorder
Light Therapy application of specialized light treatments to improve unction or well-being
Narcosynthesis administration of IV barbiturates in order to release suppressed or repressed thoughts
Psychological Tests administration and interpretation of standardized tests and measurement instruments for the assessment of psychological function
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Summary

• The 7 Key Documentation Elements
• Acuity acute versus chronic
• Site be as specific as possible
• Laterality right, left, bilateral for paired
  organs and anatomic sites
• Etiology causative disease or contributory
  drug, chemical, or non-medicinal substance
• Manifestations any other associated conditions
• External Cause of Injury circumstances of the
  injury or accident and the place of occurrence
• Signs Symptoms clarify if related to a
  specific condition or disease process