Today we're going to look at the Chapter
5 guidelines in the ICD-10-CM code book.
This chapter covers mental, behavioral
and neurodevelopmental disorders. You
note there are no changes to the
Chapter 5 guidelines in 2017 so you can
use those guidelines directly in front of
the chapter. The first guideline I want to
look at, Pain disorders related to
psychological factors. The patient has
perceived abdominal pain determined to
be persistent somatoform pain disorder.
In this statement, the physician has
stated that the pain is diagnosed as being
exclusively psychological therefore no
code from category G89 would be added.
The word. as coders that we need to
remember, is "psychogenic" which means "of
psychological origin" and that is the
term we will use when we are searching
in the index for this type of pain. We
can find a code either under psychogenic
pain or under a pain disorder
exclusively related to psychological
factors. The key word we're looking for
here is "exclusive". The rationale is that
we would assign this code for pain that is
exclusively related to psychological
disorders and if we had thought we might
use a G89 code, when you get to the
G89 category, there's an Excludes 1
note there that tells you cannot use
a code from category G89 along with the
code F45.41. If we pay attention
to the guidelines as well as the
instructional notes, we won't make as
many coding errors because we will be
following those guidelines that will
lead us down the right path. This case
has to do with the patient having
chronic pain due to trauma however there
are psychological factors also. The
doctor is not saying the pain is
exclusively related but he is saying
it's related.There's factors there he
can't exclude, so the pain would be your
principal diagnosis, chronic pain due to
trauma and then we would have the F45.42
code for that related
psychological factors. The coding
guidelines tells us that we can use a
F45.42 code along with codes
category G89 because they're not
exclusively psychological. The next
guideline has to do with mental and
behavioral disorders due to psychoactive
substance use, in remission. The point that
this guideline is making is that the
provider has to document "in remission"
and has to be the provider's clinical
judgment. It cannot be nursing (judgement), for example.
There are some situations in the medical
chart that we can use nursing
documentation or other professional
documentation but this is not one of
those times. So because the physician
stated "in remission", dependence would be
our main term in the index (followed by) drug, opioid,
in remission, leading us to code F11.21.
I have here a note that a practical
example would be that you might see a
physician state a patient had dependence
and a nursing assessment say they were
in remission. You would have to code
from the physician's documentation. You would
not consider the nursing documentation.
You could also have a situation where
the doctor would say "dependence" in one
place and "in remission" or no
remission mentioned in another place. In
that case, I would submit a query. This
guideline has to do with the hierarchy
of use, abuse and dependence when you're
talking about the same substance. The
physician dictated the H&P which stated
"cannabis dependence" but he also wrote a
progress note that same day that says
"cannabis abuse". According to
the hierarchy, you're only going to code
the "dependence" because that's the more
severe of those two terms. The hierarchy
is listed here as well as on the next page.
What you're doing is always coding to
the more severe of the terms. You can see
here the way they're written but
honestly, if I were in the field and a
doctor did this, depending on what else
is written in the record I would
probably query him or her just to
clarify and be sure i was coding the
correct thing. It's too important to
have a label placed on a patient so
I want to be sure that I'm choosing the
correct words. If I chose not to query
and I followed the guideline, i would be
in compliance but I personally
would rather query the physician and
have clarification. The next guideline
has to do with psychoactive substance
use when and if it does or does not
affect the given situation. If the
physician had written that a 27 year old
female tripped and broke her right ankle,
her friends reported they were drinking
and dancing, it does not in any way state
that she has an alcohol abuse problem or
dependence problem so you would not code
that. You would not want to add that to
this record. What I do want to use this
case for is to show you a situation or an
example when the index puts us "in the
neighborhood" (of a code) but not in the right house (not the exact code).
In other words, gets us to the right
place in the Tabular but not the exact
code. When you look up "fracture, ankle" in
the index, it takes you to S82.89.
S82.899-
That last digit "9" is an unspecified code.
Fracture of lower extremity, unspecified
The information given to us in this
scenario is not unspecified; it tells us
it's the ankle that's fractured, so as a
professional coder,
you would go to the
S82 category, to the top of this category
of codes, to see if I could find a more
specific code and I do. S82.891-
is specific to the right ankle fracture
so I have chosen a more specific code.
You always want to code with as much
specificity as you can. The seventh
character "A" would be used to identify it
is the initial encounter and that
seventh character would be added to the
S82 code. The next three codes that
are there are what's called "external
cause codes". I'm not going to get into
them. They're pretty complicated, I'm really
touching on those nearer to the end
of the semester but I don't want to talk
about those today.
in this case, the code for alcohol use
would not be coded because it's not
associated with a mental or behavioral
disorder per the provider's documentation.
If we have the same situation, but in
this scenario, the physician is stating
she had some elevated blood alcohol
consistent with her ongoing alcohol
abuse. In this case, because the doctor
has said so, we would code F10.10
alcohol abuse code. We still have the
ankle fracture as the principal
diagnosis. We would still have the
external cause codes because they are
related and explain what happened but we
would add the alcohol abuse code. If you
have any questions relating to the
Chapter 5 guidelines, please post them
in the discussion board and I will
attempt to answer them. Thank you so much.
and have a good day
you