Each month, AmeriHealth will feature an example of how ICD-9 codes will translate to ICD-10 codes. We will present coding examples from different specialties and popular disease categories to demonstrate the granularity that the new ICD-10 code set will provide.

CODING CONVENTION/GUIDELINE: MENTAL AND BEHAVIORAL DISORDERS

As in ICD-9, the codes for mental and behavioral disorders are located in Chapter 5 of ICD-10. However, in ICD-10, the clinical terminology and classification of many conditions are different. There are also more subchapters, categories, subcategories, and codes that provide greater clinical detail. This includes some changes in names and definitions of disorders to reflect more current clinical terminology and standardization of the terms used to diagnosis mental, behavioral, and substance use disorders. One difference involves the classification of substance use, abuse, and dependence. In ICD-10, the terms are not interchangeable as they are in ICD-9; they are separate conditions in ICD-10. Condition: Alcohol-induced psychotic disorder with delusions Substance ICD-9 ICD-10 Use 291.5 Alcohol-induced psychotic disorder with delusions F10.950 Alcohol use, unspecified with alcohol-induced psychotic disorder with delusions Abuse 291.5 Alcohol-induced psychotic disorder with delusions F10.150 Alcohol abuse with alcohol-induced psychotic disorder with delusions Dependence 291.5 Alcohol-induced psychotic disorder with delusions F10.250 Alcohol dependence with alcohol-induced psychotic disorder with delusions Alcohol dependence, drug dependence, and non-dependent abuse of drugs are classified into three different categories. The ICD-10 codes identify the aspects of use (e.g., withdrawal state), the effects (e.g., dependence), and the manifestations (e.g., with delirium). Condition: Opioid use, abuse, and dependence Categories ICD-10 Aspects of use F11.23 Opioid dependence with withdrawal Effects F11.10 Opioid abuse, uncomplicated F11.20 Opioid dependence, uncomplicated Manifestations F11.151 Opioid abuse with opioid-induced psychotic disorder with hallucinations F11.282 Opioid dependence with opioid-induced sleep disorder F11.921 Opioid use, unspecified with intoxication delirium In addition to the clinical terminology and classification changes, unlike ICD-9, there are chapter-specific guidelines for mental and behavioral disorders in ICD-10. These consist of pain disorders related to psychological factors and disorders due to psychoactive substance use (i.e., in remission, psychoactive substance use, abuse, and dependence). Pain disorders related to psychological factors There is a distinctive code assignment when the pain is exclusively related or indirectly related to psychological factors. Mental and behavioral disorders due to psychoactive substance use In remission: The appropriate code assignments for "in remission" are assigned only on the basis of provider documentation. Psychoactive substance use, abuse, and dependence: When the provider documentation refers to use, abuse, and dependence of the same substance (e.g., alcohol, opioid, cannabis, etc.), only one code should be assigned to identify the pattern of use based on the following hierarchy: If both use and abuse are documented, assign only the code for abuse. If both abuse and dependence are documented, assign only the code for dependence. If use, abuse, and dependence are all documented, assign only the code for dependence. If both use and dependence are documented, assign only the code for dependence. For additional information related to the AmeriHealth transition to ICD-10, please visit the ICD-10 section of our website. On this site you will also find other examples of how ICD-9 codes will translate to ICD-10 codes in the ICD-10 Spotlight: Know the codes booklet.