Office Practice Coding Assistance - Overview Three office coding assistance resources are provided in the STABLE Resource Toolkit. Depression & Bipolar Coding Reference: n Provides ICD9CM and DSM-IV-TR codes n Provides description for each code Depressive Coding and Diagnostic Criteria n Major Depressive s code n Dysthymic code n Depression NOS code n DSM-IV-TR criteria to support selection of each code Bipolar Coding and Diagnostic Criteria n Bipolar I codes n Bipolar II code n Cyclothymic code n Bipolar Not Otherwise Specified (NOS) code n Detailed DSM-IV-TR criteria to support selection of each code
Depression & Bipolar Coding Reference Depression ICD-9 and DSM IV-TR Code Diagnosis Code Description 296.2x Major depressive disorder, single episode 296.3x Major depressive disorder, recurrent episode 300.4x Dysthymic disorder, depression with anxiety; depressed reaction 311 Depressive disorder, NOS, not elsewhere classified Bipolar ICD-9 and DSM IV-TR Code Diagnosis Code Description 296.0x Bipolar I disorder, single manic/hypomanic episode 296.40 Bipolar I disorder-most recent episode hypomanic 296.4x Bipolar I disorder-most recent or current episode manic 296.5x Bipolar I disorder-most recent episode or current episode depressed 296.6x Bipolar I disorder-most recent episode or current episode mixed 296.7x Bipolar I disorder-most recent episode or current episode unspecified 296.80 Bipolar disorder-not Elsewhere Classified-includes Bipolar NOS Manic-Depressive Syndrome NOS Manic-Depressive reaction NOS 296.89 Bipolar II disorder 301.13 Cyclothymic disorder Valid ICD-9 codes but not included in DSM-IV coding 296.1x Includes any condition in 296.0x which is now stated to be recurrent. 296.81 Atypical manic disorder 296.82 Atypical depressive disorder X = a 5th digit used to specify severity 0 Unspecified severity 1 Mild severity 4 Severe-with mention of psychosis 2 Moderate severity 5 In partial or unspecified remission 3 Severe-without mention of psychosis 6 In full remission
Depressive Coding And Diagnostic Criteria Major Depressive s 296.2x 296.3x The essential feature of a Major Depressive is a period of at least 2 weeks during which there is either depressed mood or the loss of interest or pleasure in nearly all activities. Single Recurrent n Presence of a single major depressive episode n Diagnostic criteria 1&2. n Presence of two or more major depressive episodes. Note: to be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a major depressive episode. n Diagnostic criteria 1&2. Dysthymic 300.4 311 A mild depression that lasts for two years without a break Dysthymic Depressive NOS n Depressed mood for most of the day, for more days than not, as indicated by subjective account or observation by others. n Presence, while depressed of two or more of the following: Poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self esteem, poor concentration, feelings of hopelessness. n During the 2-year period the person has not been without symptoms n Diagnostic Criteria 2. n The disturbance does not occur during the course of a chronic Psychotic disorder. n The symptoms are not due to the direct physiological effects of a substance (drug abuse or medication) or of a general medical condition. n The symptoms cause clinically significant distress or impairment in social, occupational or other area of function. Depressive The Depressive Not otherwise Specified (NOS) category includes NOS disorders with depressive features that do not meet criteria for Major Depressive or Dysthymic n Premenstrual dysphoric disorder n Minor depressive disorder episodes of at least 2 weeks but with fewer than the 5 items required for MDD. n Recurrent brief depressive disorders n Post psychotic depressive disorder n A MDD superimposed on delusional disorder, Psychotic NOS or the active phase of Schizophrenia n Situations in which the clinician has concluded that a depressive disorder is present but is unable to determine whether it is primary, due to a general medical condition, or substance induced. DSM-IV-TR Diagnostic Criteria: 1. The depressive episodes are not better accounted for by Schizoaffective and are not superimposed on Schizophrenia, Schizophreniform, Delusional, or Psychotic Not Otherwise Specified. 2. There has never been a manic episode, a mixed episode, or a hypomanic episode. Note: This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition. American Psychiatric Association, 2000: Diagnostic and Statistical Manual of Mental s, Forth Edition, Text Revision, Washington, DC
Bipolar Coding And Diagnostic Criteria Bipolar I Diagnosis of Bipolar I disorder requires at least one manic or mixed episode, but there may be episodes of hypomania or major depression 296.0x 296.40 296.4x 296.5x 296.6x 296.7x Single Manic Hypomanic Manic Depressed Mixed Unspecified n Presence of only one manic episode and no past major depressive episodes. n Currently or most recently in a hypomanic episode n Diagnostic criteria 1 & 2. n Currently or most recently in a manic episode. n There has previously been at least one major depressive episode, manic episode or mixed episode. n Currently or most recently in a major depressive episode n There has previously been at least one manic episode or mixed episode n Currently or most recently in a mixed episode. n There has previously been at least one major depressive episode, manic episode or mixed episode. n Diagnostic Criteria 1. n Criteria, except for duration, are currently or most recently met for a manic, a hypomanic, a mixed, or a major depressive disorder. n There has previously been at least one manic episode or mixed episode n Diagnostic criteria 1, 2 and 3. DSM-IV-TR Diagnostic Criteria: 1. The mood episodes are not better accounted for by Schizoaffective and are not superimposed on Schizophrenia, Schizophreniform, Delusional, or Psychotic Not Otherwise Specified. 2. The mood symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning. 3. The mood symptoms are not due to the direct physiological effects of a substance (a drug of abuse, a medication, or other treatment) or a general medical condition. American Psychiatric Association, 2000: Diagnostic and Statistical Manual of Mental s, Forth Edition, Text Revision, Washington, DC
Bipolar Coding And Diagnostic Criteria - continued Bipolar II The diagnosis of this bipolar disorder requires neither a manic or a mixed episode, but does require at least one episode of hypomania in addition to an episode of major depression 296.89 Bipolar II n Presence or history of one or more major depressive episode. n Presence or history of at least one hypomanic episode. n There has never been a manic episode or a mixed episode n Diagnostic criteria 1 & 2. Cyclothymic Diagnosis of this bipolar disorder requires a history of numerous hypomanic episodes intermingled with numerous episodes of depression that do not meet criteria for major depressive episodes. 301.13 Cyclothymic n A 2 year history of numerous of hypomanic and depressive symptoms that do not meet criteria for a major depressive episode and the patient has not been without symptoms for more than 2 months. n No major depressive disorder, manic or mixed episode has been present during the first 2 years of the disturbance n Diagnostic criteria 1, 2 and 3. Bipolar The Bipolar Not Otherwise Specified category includes Not disorders with bipolar features that do not meet criteria for any specific Otherwise bipolar disorder. Specified 296.80 Bipolar NOS n Vary rapid alteration between manic and depressive symptoms that meet symptom threshold criteria but not minimal duration criteria. n Recurrent hypomanic episodes without intercurrent depressive symptoms. n A manic or mixed episode superimposed on delusional disorder, residual schizophrenia or psychotic disorder NOS. n Hypomanic episodes along with chronic depressive symptoms, that are too infrequent to qualify for a diagnosis of cyclothymic disorder. n Situations where bipolar disorder is present but the clinician is unable to determine whether it is primary or secondary to a general medical condition or substance abuse. DSM IV-TR Diagnostic Criteria: 1. The mood episodes are not better accounted for by Schizoaffective and are not superimposed on Schizophrenia, Schizophreniform, Delusional, or Psychotic Not Otherwise Specified. 2. The mood symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning. 3. The mood symptoms are not due to the direct physiological effects of a substance (a drug of abuse, a medication, or other treatment) or a general medical condition.