Coding corner: coding for bipolar disorders

As you’ve read previously in The Record, the transition to ICD-10 coding begins Oct. 1, 2015. Here’s a look at coding for bipolar disorders, including what will be different when the transition to ICD-10 takes place and a review for how to handle coding while ICD-9 coding is still in effect.

About bipolar disorder
Bipolar disorder, also known as manic depression or bipolar affective disorder, causes serious mood swings with emotional highs (manias) and lows (depression). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, defines two types of bipolar disorder:

• Type I consists of manic and mixed manic-depressive episodes lasting at least seven days or by manic symptoms severe enough to warrant hospitalization. Depressive episodes typically last two weeks or longer.
• Type II is defined by a pattern of depressive and manic episodes, but is less severe than bipolar I disorder.

ICD-10: Fewer codes
Beginning Oct. 1, 2015, the transition to ICD-10 provides fewer code choices for bipolar disorders (28 vs. 38 ICD-9 codes). The universal fifth-digit concept used in ICD-9 is no longer applicable. Instead, each code previously requiring a fifth-digit subclassification has its own list of fifth digits.

Refer to the table below for the full list of ICD-10 subcategories and subclassifications. The red dashes you see next to some of the subcategories are used to show that a fifth digit from the right column is needed for the code to be valid. Note: For bipolar disorder, sixth- and seventh-character ICD-10 codes aren’t used.

Proper ICD-9 coding
Coding for bipolar disorders depends on specific documentation of the provider’s clinical observations and medical decisions. For proper code selection, the documentation should include:

• Type I or type II disorder designation
• Features of the current or most recent episode — manic, depressed or mixed (manic-depressive)
• The severity of the most recent episode — mild, moderate or severe
• Diagnosis of partial or complete remission if the patient is asymptomatic

Proper code selection can’t be achieved if the provider hasn’t sufficiently documented any of the items listed above.

ICD-9: Coding and the fifth digit
All codes listed below, with the exception of 296.7, require fifth-digit subclassification in order to be valid and billable. The fifth-digit red “x” refers to one of seven possible severity subclassifications. Use the key below as a code reference.

296.0x - Bipolar I disorder, single manic episode
296.1x - Manic disorder, recurrent episode
296.4x - Bipolar I disorder, most recent episode (or current), manic
296.5x - Bipolar I disorder, most recent episode (or current), depressed
296.6x - Bipolar I disorder, most recent episode (or current), mixed
296.7 - Bipolar I disorder, most recent episode (or current), unspecified
296.80 - Other and unspecified bipolar disorders, bipolar disorder, unspecified
296.89 - Bipolar II disorder

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.