Documenting and Coding of Bipolar Disorder Using ICD-10 Codes

Documenting & Coding of BIPOLAR DISORDER Using ICD-10 Codes

Bipolar disorder is a mental health condition that causes dramatic shifts in a person’s mood, energy and ability to think clearly. The article discusses the diagnosis and coding guidelines related to this condition.

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Bipolar disorder, (also known as manic depression) is a mental illness that causes extreme mood swings or depression that include emotional highs (mania or hypomania) and lows (depression).This condition is marked by extreme shifts in mood and fluctuations in energy and activity levels that can make day-to-day living very complex. Often called mood episodes, these emotional mental states may occur rarely or multiple times in a year and are categorized as manic, hypomanic or depressive. Although there is no specific cure for this mental health condition, medications, substance abuse treatment, psychological counseling (psychotherapy) and lifestyle changes can dramatically reduce or improve the symptoms. Psychiatrists or psychologists are specialized in diagnosing, treating, and managing mental health conditions such as bipolar and other related disorders.

Documenting this disorder requires accurate recording of all the present symptoms and the treatment modalities provided. Coding for bipolar disorder can be a challenging process and for proper clinical documentation, physicians can benefit from the services of medical billing outsourcing companies.

Reports suggest that about 2.9 percent of Americans have been diagnosed with this rare brain disorder and about 83 percent of cases are classified as severe. The average age of diagnosis is between 15-25 years and it can affect both males and females equally. The exact cause of bipolar disorder is unknown, but several factors such as genetics and biological differences may be involved. If left untreated, this disorienting condition has a potential for adverse consequences, particularly a high risk for suicide, problems related to drug and alcohol use, legal or financial problems and other issues. Therefore, it is critical to obtain or provide treatment for this condition at the right time.

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What Are the Signs and Symptoms?

Symptoms of bipolar disorder vary between people and according to mood. In some cases, people experience clear mood swings, with symptoms of mania and then of depression each lasting for several months. Some people experience "high" or "low" mood swings for months or years. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. These bipolar symptoms may change with the seasons or occur during pregnancy.

Mania or Hypomania Mania or hypomania refers to a "high" mood. Symptoms include  Impaired judgment  Feeling "wired"  Exaggerated sense of well-being and self-confidence (euphoria)  Decreased need for sleep  Unusual talkativeness  Racing thoughts  A sense of distraction or boredom  A sense of being on top of the world, exhilarated, or euphoric  Missing work or school, or underperforming  Likelihood of engaging in risky behavior Depression During a depressive episode, a person may experience certain symptoms that are severe enough to cause noticeable difficulty

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 Depressed mood such as a feeling of gloom, blackness, despair, and hopelessness  Marked loss of interest or feeling no pleasure in almost all activities  Extreme sadness  Insomnia and sleeping problems  Anxiety about trivial things  Extreme tiredness or fatigue  Changes in eating patterns, whether eating more or eating less  Weight loss or weight gain  Decreased ability to think or concentrate, or indecisiveness  Thinking about, planning or attempting suicide Symptoms of bipolar disorder can be quite difficult to identify among children and teens as this age group often has greater changes in mood, behavior, and energy levels. Severe mood swings (that are quite different from their usual mood swings) are one of the most prominent signs of this mental disorder.

Diagnosis and Treatment of Bipolar Disorder Bipolar disorder is difficult to diagnose as the signs and symptoms and the related mood swings can vary, have different patterns and may not correctly fit into specific diagnostic categories. The initial diagnosis may begin with a detailed physical exam and lab tests to identify medical problems that could be causing your symptoms. A psychiatric assessment will be done to understand your feelings, thoughts and other behavioral patterns. Patients will be asked to maintain a detailed record of their mood swings and sleep patterns, which could help in early diagnosis and incorporating the correct treatment options.

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A psychiatrist/psychologist may compare the symptoms and make the final diagnosis based on the criteria for bipolar and related disorders set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. Patients must fulfill certain specific criteria for mania and depression (including an “elevated or irritable mood” and "persistently increased activity or energy levels”). These criteria’s must have lasted for at least 7 days, or less if symptoms were severe enough to need hospitalization.

Treatment for this condition aims to minimize the frequency of manic and depressive episodes, and to reduce the severity of symptoms to enable a relatively normal life. Top treatment modalities involve a combination of therapies including medications, education

psychological

and

support

counseling/interventions

groups.

Medications

(psychotherapy)

include

mood

and

stabilizers,

antipsychotics, antidepressants and anti-anxiety medications. In addition, electroconvulsive therapy (ECT) – where in an electrical current is passed through the brain, intentionally triggering a brief seizure -- will be opted as a last resort.

ECT helps bring changes in brain chemistry that can reverse the symptoms of certain mental illnesses.

ICD-10 Codes to Use to Report Bipolar Disorder Psychiatry medical coding involves the use of the correct ICD-10 codes to document

any

such

conditions,

including

bipolar

disorder.

Psychiatrists/Psychologists who treat this mental disorder rely on reputable medical billing companies to code the condition accurately. ICD-10-CM codes used for the diagnosis of bipolar disorder include –

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F31 - Bipolar disorder  F31.0 - Bipolar disorder, current episode hypomanic F31.1 - Bipolar disorder, current episode manic without psychotic features  F31.10 - Bipolar disorder, current episode manic without psychotic features, unspecified  F31.11 - Bipolar disorder, current episode manic without psychotic features, mild  F31.12 - Bipolar disorder, current episode manic without psychotic features, moderate  F31.13 – Bipolar disorder, current episode manic without psychotic features, severe  F31.2 - Bipolar disorder, current episode manic severe with psychotic features F31.3 - Bipolar disorder, current episode depressed, mild or moderate severity  F31.30 - Bipolar disorder, current episode depressed, mild or moderate severity, unspecified  F31.31 - Bipolar disorder, current episode depressed, mild  F31.32 - Bipolar disorder, current episode depressed, moderate  F31.4 - Bipolar disorder, current episode depressed, severe, without psychotic features  F31.5 - Bipolar disorder, current episode depressed, severe, with psychotic features

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F31.6 - Bipolar disorder, current episode mixed  F31.60 - Bipolar disorder, current episode mixed, unspecified  F31.61 - Bipolar disorder, current episode mixed, mild  F31.62 - Bipolar disorder, current episode mixed, moderate  F31.63 - Bipolar disorder, current episode mixed, severe, without psychotic features  F31.64 - Bipolar disorder, current episode mixed, severe, with psychotic features F31.7 - Bipolar disorder, currently in remission  F31.70 - Bipolar disorder, currently in remission, most recent episode unspecified  F31.71 - Bipolar disorder, in partial remission, most recent episode hypomanic  F31.72 - Bipolar disorder, in full remission, most recent episode hypomanic  F31.73 - Bipolar disorder, in partial remission, most recent episode manic  F31.74 - Bipolar disorder, in full remission, most recent episode manic  F31.75 - Bipolar disorder, in partial remission, most recent episode depressed  F31.76 - Bipolar disorder, in full remission, most recent episode depressed  F31.77 - Bipolar disorder, in partial remission, most recent episode mixed  F31.78 - Bipolar disorder, in full remission, most recent episode mixed F31.8 - Other bipolar disorders  F31.81 - Bipolar II disorder  F31.89 - Other bipolar disorder www.outsourcestrategies.com

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F31.9 - Bipolar disorder, unspecified There are several risk factors associated with bipolar disorder which may include drug or alcohol abuse, periods of high stress (such as the death of a loved one or other traumatic event) and genetics (such as a parent or sibling, with the same condition). Patients need to make significant positive lifestyle changes to stop cycles of behavior that worsen their condition. Incorporating simple steps such as quitting drinking or recreational drug use habits, maintaining a healthy routine for eating and sleeping, recognizing severe mood swings, doing regular exercise and reducing/avoiding stressful situations can help people better manage their bipolar disorder symptoms in the long run.

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